Provider Demographics
NPI:1780216192
Name:GUSSIE MAE SPECIAL NEEDS ADULT DAYCARE CENTER, INC.
Entity type:Organization
Organization Name:GUSSIE MAE SPECIAL NEEDS ADULT DAYCARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JONIKA
Authorized Official - Middle Name:
Authorized Official - Last Name:GERALD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:972-230-7723
Mailing Address - Street 1:PO BOX 3933
Mailing Address - Street 2:
Mailing Address - City:CEDAR HILL
Mailing Address - State:TX
Mailing Address - Zip Code:75106-3933
Mailing Address - Country:US
Mailing Address - Phone:972-230-7723
Mailing Address - Fax:972-230-7724
Practice Address - Street 1:215 DALTON DR STE E
Practice Address - Street 2:
Practice Address - City:DESOTO
Practice Address - State:TX
Practice Address - Zip Code:75115-4453
Practice Address - Country:US
Practice Address - Phone:972-230-7723
Practice Address - Fax:972-230-7724
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-02-04
Last Update Date:2023-01-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care