Healthcare Provider Details

I. General information

NPI: 1255642138
Provider Name (Legal Business Name): TEAM 2
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/25/2010
Last Update Date: 06/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4147 LABYRINTH RD
BALTIMORE MD
21215-2202
US

IV. Provider business mailing address

4147 LABYRINTH RD
BALTIMORE MD
21215-2202
US

V. Phone/Fax

Practice location:
  • Phone: 443-278-9290
  • Fax: 443-278-9000
Mailing address:
  • Phone: 443-278-9290
  • Fax: 443-278-9000

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: JOSEPH SHPARAGA
Title or Position: VICE PRESIDENT
Credential:
Phone: 443-278-9290