Healthcare Provider Details

I. General information

NPI: 1891308243
Provider Name (Legal Business Name): HEALTHY LIFE ADULT MEDICAL DAY CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2020
Last Update Date: 08/26/2020
Certification Date: 08/26/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

401 REISTERSTOWN RD
BALTIMORE MD
21208-5320
US

IV. Provider business mailing address

401 REISTERSTOWN RD
BALTIMORE MD
21208-5320
US

V. Phone/Fax

Practice location:
  • Phone: 443-858-7935
  • Fax:
Mailing address:
  • Phone:
  • Fax:

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: ELENA KUPERMAN
Title or Position: OWNER
Credential:
Phone: 443-858-7935