Healthcare Provider Details

I. General information

NPI: 1417171372
Provider Name (Legal Business Name): KENT CO. MEDICAL ADULT DAY CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/12/2007
Last Update Date: 06/23/2022
Certification Date: 06/23/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

125 S LYNCHBURG ST
CHESTERTOWN MD
21620-1146
US

IV. Provider business mailing address

125 S LYNCHBURG ST
CHESTERTOWN MD
21620-1146
US

V. Phone/Fax

Practice location:
  • Phone: 410-778-1350
  • Fax: 410-775-6119
Mailing address:
  • Phone: 410-778-1350
  • Fax: 410-775-6119

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. WILLIAM HEROY WEBB
Title or Position: HEALTH OFFICER/DIRECTOR
Credential:
Phone: 410-778-1350