Healthcare Provider Details

I. General information

NPI: 1306968086
Provider Name (Legal Business Name): EXTENDED FAMILY ADULT DAYCARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/04/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4200 EDMONDSON AVE SUITE 100
BALTIMORE MD
21229-1612
US

IV. Provider business mailing address

4200 EDMONDSON AVE SUITE 100
BALTIMORE MD
21229-1612
US

V. Phone/Fax

Practice location:
  • Phone: 410-233-0048
  • Fax: 410-233-7004
Mailing address:
  • Phone: 410-233-0048
  • Fax: 410-233-7004

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number10242
License Number StateMD

VIII. Authorized Official

Name: MS. HELEN HUTCHINSON
Title or Position: PROGRAM DIRECTOR
Credential: MA
Phone: 410-233-0048