Healthcare Provider Details

I. General information

NPI: 1760523542
Provider Name (Legal Business Name): ACTIVE DAY MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 05/22/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1430 JOH AVE STE A
BALTIMORE MD
21227-1037
US

IV. Provider business mailing address

6 NESHAMINY INTERPLEX DR STE 401
TREVOSE PA
19053-6942
US

V. Phone/Fax

Practice location:
  • Phone: 410-242-0379
  • Fax:
Mailing address:
  • Phone: 215-642-6600
  • Fax: 215-642-6610

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: ROBERT CREAMER
Title or Position: CEO
Credential:
Phone: 215-642-6600