Healthcare Provider Details

I. General information

NPI: 1518056779
Provider Name (Legal Business Name): ACTIVE DAY MD, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2006
Last Update Date: 05/29/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

400 REDLAND CT SUITE 114
OWINGS MILLS MD
21117-3270
US

IV. Provider business mailing address

400 REDLAND CT SUITE 114
OWINGS MILLS MD
21117-3270
US

V. Phone/Fax

Practice location:
  • Phone: 443-548-2200
  • Fax: 443-548-2260
Mailing address:
  • Phone: 443-548-2200
  • Fax: 443-548-2260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QR0400X
TaxonomyRehabilitation Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: KRIS W BALDOCK
Title or Position: CHAIRMAN, CEO, PRESIDENT
Credential:
Phone: 443-548-2201