Provider Demographics
NPI:1871971770
Name:INTERFAITH ADULT DAY CARE, INC.
Entity type:Organization
Organization Name:INTERFAITH ADULT DAY CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:JACQUELINE
Authorized Official - Middle Name:DELORES
Authorized Official - Last Name:MEALING
Authorized Official - Suffix:
Authorized Official - Credentials:BS
Authorized Official - Phone:804-732-3919
Mailing Address - Street 1:201 WALNUT BLVD
Mailing Address - Street 2:P.O. BOX 3272
Mailing Address - City:PETERSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:23805-2025
Mailing Address - Country:US
Mailing Address - Phone:804-732-3919
Mailing Address - Fax:804-732-2163
Practice Address - Street 1:201 WALNUT BLVD
Practice Address - Street 2:
Practice Address - City:PETERSBURG
Practice Address - State:VA
Practice Address - Zip Code:23805-2025
Practice Address - Country:US
Practice Address - Phone:804-732-3919
Practice Address - Fax:804-732-2163
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-05-12
Last Update Date:2015-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VAADC14950036261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care