Provider Demographics
NPI:1912189861
Name:HAPPY CARE ADULT DAY CENTER, LLC
Entity Type:Organization
Organization Name:HAPPY CARE ADULT DAY CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:JERRY
Authorized Official - Middle Name:
Authorized Official - Last Name:MONTGOMERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-928-7800
Mailing Address - Street 1:4915 BRASHEAR ST
Mailing Address - Street 2:
Mailing Address - City:DALLAS
Mailing Address - State:TX
Mailing Address - Zip Code:75210
Mailing Address - Country:US
Mailing Address - Phone:214-928-7800
Mailing Address - Fax:214-928-7803
Practice Address - Street 1:4915 BRASHEAR ST.
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75210
Practice Address - Country:US
Practice Address - Phone:214-928-7800
Practice Address - Fax:214-928-7803
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-12-03
Last Update Date:2007-12-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX122010261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX122010OtherMEDICARE ADULT DAY CENTER
TX122010Medicaid