Basic Information
Provider Information | |||||||||
NPI: | 1538285879 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | ADULT DAY CARE OF AMERICA, INC. | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | ALMOST FAMILY | ||||||||
OtherOrganizationType: | 3 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | PO BOX 51266 | ||||||||
Address2: |   | ||||||||
City: | LAFAYETTE | ||||||||
State: | LA | ||||||||
PostalCode: | 705051266 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 3372331307 | ||||||||
FaxNumber: | 3374434154 | ||||||||
Practice Location | |||||||||
Address1: | 60 LONG RIDGE RD STE 308 | ||||||||
Address2: |   | ||||||||
City: | STAMFORD | ||||||||
State: | CT | ||||||||
PostalCode: | 069021841 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2039690101 | ||||||||
FaxNumber: | 2033168854 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 03/21/2007 | ||||||||
LastUpdateDate: | 10/14/2020 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | GACHASSIN | ||||||||
AuthorizedOfficialFirstName: | NICHOLAS | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | SECRETARY / TREASURER | ||||||||
AuthorizedOfficialTelephone: | 3372331307 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: | III | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 10/14/2020 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 251E00000X |   |   | N |   | Agencies | Home Health |   | 372500000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Related Providers | Chore Provider |   | 372600000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Related Providers | Adult Companion |   | 376J00000X |   |   | N | 193200000X MULTI-SPECIALTY GROUP | Nursing Service Related Providers | Homemaker |   | 253Z00000X |   |   | Y |   | Agencies | In Home Supportive Care |   |
ID Information
ID | Type | State | Issuer | Description | 008044874 | 05 | CT |   | MEDICAID |