Provider Demographics
NPI:1508611583
Name:SAM'S LEGACY ADULT DAY CENTER
Entity Type:Organization
Organization Name:SAM'S LEGACY ADULT DAY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:FLORENCE
Authorized Official - Middle Name:
Authorized Official - Last Name:OSHOWOLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:214-334-1485
Mailing Address - Street 1:1517 WILDWOOD CIR
Mailing Address - Street 2:
Mailing Address - City:GARLAND
Mailing Address - State:TX
Mailing Address - Zip Code:75042-8408
Mailing Address - Country:US
Mailing Address - Phone:214-334-1485
Mailing Address - Fax:
Practice Address - Street 1:9020 BLUECREST DR
Practice Address - Street 2:
Practice Address - City:DALLAS
Practice Address - State:TX
Practice Address - Zip Code:75232-5704
Practice Address - Country:US
Practice Address - Phone:214-334-1485
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care