Healthcare Provider Details

I. General information

NPI: 1376419580
Provider Name (Legal Business Name): ADORABLE LUCILLE ASSISTANT LIVING FACILITY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/14/2025
Last Update Date: 10/14/2025
Certification Date: 10/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3917 MARKET ST
SNOW HILL MD
21863-4413
US

IV. Provider business mailing address

3917 MARKET ST
SNOW HILL MD
21863-4413
US

V. Phone/Fax

Practice location:
  • Phone: 443-944-1835
  • Fax:
Mailing address:
  • Phone: 443-944-1835
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343800000X
TaxonomySecured Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State

VIII. Authorized Official

Name: SHAWN JOHNSON
Title or Position: OWNER
Credential:
Phone: 443-944-1835