Healthcare Provider Details

I. General information

NPI: 1770909871
Provider Name (Legal Business Name): MEDCLUB ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/13/2014
Last Update Date: 03/13/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5610 HARFORD RD
BALTIMORE MD
21214-2247
US

IV. Provider business mailing address

5610 HARFORD RD
BALTIMORE MD
21214-2247
US

V. Phone/Fax

Practice location:
  • Phone: 410-254-3000
  • Fax:
Mailing address:
  • Phone: 410-254-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number30025A
License Number StateMD

VIII. Authorized Official

Name: MS. SAMIA EL BAROUDY
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 443-935-0045