Provider Demographics
NPI:1952791113
Name:VALECIA CARDELL BEHOLD SENIOR ACTIVITY DAY CENTER
Entity type:Organization
Organization Name:VALECIA CARDELL BEHOLD SENIOR ACTIVITY DAY CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER / DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VALECIA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARDELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:423-486-2157
Mailing Address - Street 1:6701 SHALLOWFORD RD
Mailing Address - Street 2:
Mailing Address - City:CHATTANOOGA
Mailing Address - State:TN
Mailing Address - Zip Code:37421-1711
Mailing Address - Country:US
Mailing Address - Phone:423-771-7568
Mailing Address - Fax:
Practice Address - Street 1:6701 SHALLOWFORD RD
Practice Address - Street 2:
Practice Address - City:CHATTANOOGA
Practice Address - State:TN
Practice Address - Zip Code:37421-1711
Practice Address - Country:US
Practice Address - Phone:423-771-7568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-01-27
Last Update Date:2015-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care