Healthcare Provider Details

I. General information

NPI: 1508028572
Provider Name (Legal Business Name): PAYNE MEMORIAL OUTREACH, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 05/21/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1701 MADISON AVE
BALTIMORE MD
21217-3731
US

IV. Provider business mailing address

1701 MADISON AVE 1ST FLOOR
BALTIMORE MD
21217-3731
US

V. Phone/Fax

Practice location:
  • Phone: 410-462-3802
  • Fax: 410-728-4880
Mailing address:
  • Phone: 410-462-3802
  • Fax: 410-728-4880

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number30-018
License Number StateMD

VIII. Authorized Official

Name: MS. ESTHER OLIVER
Title or Position: DIRECTOR
Credential:
Phone: 410-462-3802