Provider Demographics
NPI:1548340920
Name:OLDIES BUT GOODIES ADULT DAY CARE, INC
Entity type:Organization
Organization Name:OLDIES BUT GOODIES ADULT DAY CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:ANGELA
Authorized Official - Middle Name:YVETT
Authorized Official - Last Name:BIDDINGS
Authorized Official - Suffix:
Authorized Official - Credentials:LPN
Authorized Official - Phone:219-886-1670
Mailing Address - Street 1:741 W 25TH AVE
Mailing Address - Street 2:SAME
Mailing Address - City:GARY
Mailing Address - State:IN
Mailing Address - Zip Code:46407-3524
Mailing Address - Country:US
Mailing Address - Phone:219-886-1670
Mailing Address - Fax:219-886-1670
Practice Address - Street 1:741 W 25TH AVE
Practice Address - Street 2:SAME
Practice Address - City:GARY
Practice Address - State:IN
Practice Address - Zip Code:46407-3524
Practice Address - Country:US
Practice Address - Phone:219-886-1670
Practice Address - Fax:219-886-1670
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-10-17
Last Update Date:2008-05-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home
Provider Identifiers
StateIdentifier IDID TypeIssuer
IN200266600Medicaid