Provider Demographics
NPI:1235471368
Name:YOUR SECOND HOME ADULT DAY CARE INC.
Entity type:Organization
Organization Name:YOUR SECOND HOME ADULT DAY CARE INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR & OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:GANGADAI
Authorized Official - Middle Name:SINGH
Authorized Official - Last Name:DOODNAUTH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:321-986-8500
Mailing Address - Street 1:3702 N COURTENAY PKWY
Mailing Address - Street 2:SUITE 108/110
Mailing Address - City:MERRITT ISLAND
Mailing Address - State:FL
Mailing Address - Zip Code:32953-8155
Mailing Address - Country:US
Mailing Address - Phone:321-986-8500
Mailing Address - Fax:321-986-8444
Practice Address - Street 1:3702 N COURTENAY PKWY
Practice Address - Street 2:SUITE 108/110
Practice Address - City:MERRITT ISLAND
Practice Address - State:FL
Practice Address - Zip Code:32953-8155
Practice Address - Country:US
Practice Address - Phone:321-986-8500
Practice Address - Fax:321-986-8444
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-03-27
Last Update Date:2022-03-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
FL690781400Medicaid