Healthcare Provider Details

I. General information

NPI: 1235271099
Provider Name (Legal Business Name): ACTIVE DAY MD, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2007
Last Update Date: 12/05/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

354 MOUNTAIN RD SUITE G
PASADENA MD
21122-1158
US

IV. Provider business mailing address

7 NESHAMINY INTERPLEX DR SUITE 403
TREVOSE PA
19053-6927
US

V. Phone/Fax

Practice location:
  • Phone: 410-255-2879
  • Fax: 410-255-0905
Mailing address:
  • Phone: 215-642-6600
  • Fax: 215-642-6610

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: CRAIG MEHNERT
Title or Position: COO
Credential:
Phone: 215-642-6600