Healthcare Provider Details

I. General information

NPI: 1508056268
Provider Name (Legal Business Name): TRINITY ADULT MEDICAL DAYCARE INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2007
Last Update Date: 07/31/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6200 LOCH RAVEN BLVD
BALTIMORE MD
21239-1821
US

IV. Provider business mailing address

6401 DOGWOOD ROAD, STE108
BALTIMORE MD
21207
US

V. Phone/Fax

Practice location:
  • Phone: 410-532-3400
  • Fax: 410-532-0715
Mailing address:
  • Phone: 410-298-9800
  • Fax: 410-298-5206

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: DR. JOSEPH E DEVEDOSS
Title or Position: PRESIDENT
Credential:
Phone: 410-298-9800