Healthcare Provider Details

I. General information

NPI: 1609690569
Provider Name (Legal Business Name): ADVANCED CENTERS FOR THE SPECIALLY ENABLED LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/08/2024
Last Update Date: 11/08/2024
Certification Date: 10/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9125 GUILFORD RD STE 104
COLUMBIA MD
21046-3459
US

IV. Provider business mailing address

9125 GUILFORD RD STE 104
COLUMBIA MD
21046-3459
US

V. Phone/Fax

Practice location:
  • Phone: 410-777-9063
  • Fax:
Mailing address:
  • Phone: 410-777-9063
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. RENE PALACIOS JR.
Title or Position: OWNER
Credential:
Phone: 410-777-9063