Healthcare Provider Details

I. General information

NPI: 1861529273
Provider Name (Legal Business Name): PARADISE ADULT MEDICAL DAYCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5613 BELAIR RD # 17
BALTIMORE MD
21206-3619
US

IV. Provider business mailing address

5613 BELAIR RD # 17
BALTIMORE MD
21206-3619
US

V. Phone/Fax

Practice location:
  • Phone: 410-483-4444
  • Fax: 410-483-4443
Mailing address:
  • Phone: 410-483-4444
  • Fax: 410-483-4443

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number12780
License Number StateMD

VIII. Authorized Official

Name: MRS. VITA CHERNYAKHOVSKY
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 410-483-4444