Healthcare Provider Details

I. General information

NPI: 1972719029
Provider Name (Legal Business Name): GOLDEN AGE ADULT CARE CENTER OF BOWIE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/15/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3112 BELAIR DR
BOWIE MD
20715-3101
US

IV. Provider business mailing address

3112 BELAIR DR
BOWIE MD
20715-3101
US

V. Phone/Fax

Practice location:
  • Phone: 301-262-3900
  • Fax: 301-262-3970
Mailing address:
  • Phone: 301-262-3900
  • Fax: 301-262-3970

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: FRANCES P BLACKER
Title or Position: CHIEF FINANCIAL OFFICER
Credential:
Phone: 301-262-3900