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Organization
TIPTON ADAPTIVE DAYCARE LLC
Active
Organization
TIPTON ADAPTIVE DAYCARE LLC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MRS. DEBORAH LORRAINE VANDERGAAST RN (OWNER / DIRECTOR)
(563) 886-3143
Entity
Organization
Contact information
Practice address
118 PARKVIEW CT, TIPTON, IA 52772-1349
(563) 886-3143
(563) 886-3143
Mailing address
118 PARKVIEW CT, TIPTON, IA 52772-1349
(563) 886-3143
(563) 886-3143
Taxonomy
Speciality
Code
Description
License number
State
163W00000X
Registered Nurse
Primary
104423
IA
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
104423
IA
385HR2065X
Child Physical Disabilities Respite Care
104423
IA
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
1023233806
—
IA
Enumeration date
04/02/2012
Last updated
04/02/2012
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