Provider Demographics
NPI:1184745853
Name:SLIDELL ADULT DAY HEALTH CARE
Entity type:Organization
Organization Name:SLIDELL ADULT DAY HEALTH CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:DWIGHT
Authorized Official - Middle Name:ERIC
Authorized Official - Last Name:DENHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:985-643-1112
Mailing Address - Street 1:2768 SGT ALFRED DR
Mailing Address - Street 2:
Mailing Address - City:SLIDELL
Mailing Address - State:LA
Mailing Address - Zip Code:70458-4014
Mailing Address - Country:US
Mailing Address - Phone:985-643-1112
Mailing Address - Fax:985-643-3444
Practice Address - Street 1:2768 SGT ALFRED DR
Practice Address - Street 2:
Practice Address - City:SLIDELL
Practice Address - State:LA
Practice Address - Zip Code:70458-4014
Practice Address - Country:US
Practice Address - Phone:985-643-1112
Practice Address - Fax:985-643-3444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-02
Last Update Date:2022-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
LAADHC 5001385H00000X
261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No385H00000XRespite Care FacilityRespite Care