Portraits of Life Adult Day Services, Inc.

Primary specialty

Adult Day Care Clinic/CenterTaxonomy code 261QA0600X

License

232830 Issued in PA

Legal business name

PORTRAITS OF LIFE ADULT DAY SERVICES, INC.

Practice address

419 Market Street
Lykens, PA 17048-1316

Phone

(717) 453-9355

Fax

(717) 453-0846

NPI assigned

Nov 29, 2006

Last updated

Nov 2, 2021By the provider in NPPES

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Ms. Constance Louise Eisenhauer

Title

Cfo/Owner

Phone

(717) 360-7074

Specialties & licenses 1

Addresses

Other identifiers 1

Locations

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1164758400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1635811200000",
    "number": "1477620086",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "419 MARKET STREET",
            "city": "LYKENS",
            "state": "PA",
            "postal_code": "17048",
            "telephone_number": "717-453-9355",
            "fax_number": "717-453-0846"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "419 MARKET STREET",
            "city": "LYKENS",
            "state": "PA",
            "postal_code": "170481316",
            "telephone_number": "717-453-9355",
            "fax_number": "717-453-0846"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PORTRAITS OF LIFE ADULT DAY SERVICES, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-11-29",
        "last_updated": "2021-11-02",
        "certification_date": "2021-11-02",
        "status": "A",
        "authorized_official_last_name": "EISENHAUER",
        "authorized_official_first_name": "CONSTANCE",
        "authorized_official_middle_name": "LOUISE",
        "authorized_official_title_or_position": "CFO/OWNER",
        "authorized_official_telephone_number": "717-360-7074",
        "authorized_official_name_prefix": "Ms."
    },
    "taxonomies": [
        {
            "code": "261QA0600X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Day Care",
            "state": "PA",
            "license": "232830",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "01732517",
            "state": "PA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Adult Day Care Clinic/Center in Lykens, PA
• Providers in Lykens, PA by specialty
• Adult Day Care Clinic/Center in Pennsylvania

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Nov 2, 2021; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.