Healthcare Provider Details

I. General information

NPI: 1316167521
Provider Name (Legal Business Name): ADULT DAY CARE OF CALVERT COUNTY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/27/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

975 SOLOMONS ISLAND ROAD
PRINCE FREDERICK MD
20678
US

IV. Provider business mailing address

PO BOX 1659
PRINCE FREDERICK MD
20678-1659
US

V. Phone/Fax

Practice location:
  • Phone: 410-535-0133
  • Fax: 410-535-4094
Mailing address:
  • Phone: 410-535-0133
  • Fax: 410-535-4094

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number9145
License Number StateMD

VIII. Authorized Official

Name: LISA KOCHELL
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 410-535-0133