Provider Demographics
NPI:1811070485
Name:ABILENE ADULT DAY CARE
Entity type:Organization
Organization Name:ABILENE ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:CORNWELL
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:325-672-5742
Mailing Address - Street 1:3518 S 7TH ST
Mailing Address - Street 2:
Mailing Address - City:ABILENE
Mailing Address - State:TX
Mailing Address - Zip Code:79605-2818
Mailing Address - Country:US
Mailing Address - Phone:325-672-5742
Mailing Address - Fax:325-672-5135
Practice Address - Street 1:3518 S 7TH ST
Practice Address - Street 2:
Practice Address - City:ABILENE
Practice Address - State:TX
Practice Address - Zip Code:79605-2818
Practice Address - Country:US
Practice Address - Phone:325-672-5742
Practice Address - Fax:325-672-5135
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-24
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX116368311Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
TX003306OtherTDADS FACILITY NUMBER