Provider Demographics
NPI:1245679331
Name:CONSOLIDATED ADULT DAY CARE
Entity type:Organization
Organization Name:CONSOLIDATED ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:SECRETARY
Authorized Official - Prefix:
Authorized Official - First Name:DEON
Authorized Official - Middle Name:
Authorized Official - Last Name:RIDEAU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:409-379-2759
Mailing Address - Street 1:PO BOX 1700
Mailing Address - Street 2:
Mailing Address - City:NEWTON
Mailing Address - State:TX
Mailing Address - Zip Code:75966-1700
Mailing Address - Country:US
Mailing Address - Phone:409-379-2759
Mailing Address - Fax:409-379-2371
Practice Address - Street 1:412 S KAUFMAN ST
Practice Address - Street 2:
Practice Address - City:NEWTON
Practice Address - State:TX
Practice Address - Zip Code:75966-3603
Practice Address - Country:US
Practice Address - Phone:409-379-2759
Practice Address - Fax:409-379-2371
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-06-21
Last Update Date:2013-06-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care