Healthcare Provider Details

I. General information

NPI: 1013318229
Provider Name (Legal Business Name): MONTGOMERY ADULT DAY CARE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2014
Last Update Date: 09/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9123 GAITHER RD
GAITHERSBURG MD
20877-1451
US

IV. Provider business mailing address

9123 GAITHER RD
GAITHERSBURG MD
20877-1451
US

V. Phone/Fax

Practice location:
  • Phone: 240-423-9182
  • 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 StateNULL

VIII. Authorized Official

Name: IRENE MAYZEL
Title or Position: PRESIDENT
Credential:
Phone: 240-423-9182