Healthcare Provider Details

I. General information

NPI: 1669735445
Provider Name (Legal Business Name): A PROVIDENCE MEDICAL ADULT DAY CARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2012
Last Update Date: 03/20/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 S CATON AVE
BALTIMORE MD
21229-4210
US

IV. Provider business mailing address

800 S CATON AVE
BALTIMORE MD
21229-4210
US

V. Phone/Fax

Practice location:
  • Phone: 418-889-0727
  • Fax: 410-523-1502
Mailing address:
  • Phone: 410-889-0727
  • Fax: 410-523-1502

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number30-023-A
License Number StateMD

VIII. Authorized Official

Name: ANNIE GARMAI WRIGHT
Title or Position: CENTER DIRECTOR
Credential:
Phone: 410-889-0727