Healthcare Provider Details

I. General information

NPI: 1275819872
Provider Name (Legal Business Name): CENTER FOR AGING FAMILIES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/26/2011
Last Update Date: 10/26/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

200 E JOPPA RD L-101
TOWSON MD
21286-3105
US

IV. Provider business mailing address

9606 AMBERLEIGH LN, APT E
PERRY HALL MD
21128-9743
US

V. Phone/Fax

Practice location:
  • Phone: 443-622-2368
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code1041C0700X
TaxonomyClinical Social Worker
License Number15723
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: BEVERLY PARSONS
Title or Position: SOCIAL WORKER
Credential:
Phone: 443-622-2368