Provider Demographics
NPI:1871633545
Name:SOUTHPORT ADULT DAY CENTER
Entity Type:Organization
Organization Name:SOUTHPORT ADULT DAY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM COORDINATOR
Authorized Official - Prefix:
Authorized Official - First Name:LEAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JONES
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:317-536-7245
Mailing Address - Street 1:1427 SOUTHVIEW DR
Mailing Address - Street 2:
Mailing Address - City:INDIANAPOLIS
Mailing Address - State:IN
Mailing Address - Zip Code:46227-5027
Mailing Address - Country:US
Mailing Address - Phone:317-536-7245
Mailing Address - Fax:317-536-7241
Practice Address - Street 1:1427 SOUTHVIEW DR
Practice Address - Street 2:
Practice Address - City:INDIANAPOLIS
Practice Address - State:IN
Practice Address - Zip Code:46227-5027
Practice Address - Country:US
Practice Address - Phone:317-536-7245
Practice Address - Fax:317-536-7241
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-08
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
IN261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care