Healthcare Provider Details

I. General information

NPI: 1104152594
Provider Name (Legal Business Name): HERITAGE ADULT DAYCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2009
Last Update Date: 11/30/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8240 LOCH RAVEN BLVD
TOWSON MD
21286-8200
US

IV. Provider business mailing address

304 REISTERSTOWN RD
PIKESVILLE MD
21208-5312
US

V. Phone/Fax

Practice location:
  • Phone: 410-825-5575
  • Fax: 410-825-5578
Mailing address:
  • Phone: 410-825-5575
  • Fax: 410-825-5578

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. DANIEL TROSMAN
Title or Position: PROGRAM DIRECTOR
Credential:
Phone: 410-825-5575