Provider Demographics
NPI:1962044131
Name:STILL WATERS ADULT DAY FACILITY
Entity Type:Organization
Organization Name:STILL WATERS ADULT DAY FACILITY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:JEANETTE
Authorized Official - Middle Name:M
Authorized Official - Last Name:WATERS
Authorized Official - Suffix:
Authorized Official - Credentials:PRESIDENT,LPN
Authorized Official - Phone:334-400-2932
Mailing Address - Street 1:700 BRANTLEY ST
Mailing Address - Street 2:
Mailing Address - City:OPP
Mailing Address - State:AL
Mailing Address - Zip Code:36467-1720
Mailing Address - Country:US
Mailing Address - Phone:334-400-2932
Mailing Address - Fax:
Practice Address - Street 1:700 BRANTLEY ST
Practice Address - Street 2:
Practice Address - City:OPP
Practice Address - State:AL
Practice Address - Zip Code:36467-1720
Practice Address - Country:US
Practice Address - Phone:334-400-2932
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-09
Last Update Date:2019-10-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care