Healthcare Provider Details

I. General information

NPI: 1598983363
Provider Name (Legal Business Name): RANDOLPH HILLS ADULT DAY CARE CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/24/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4011 RANDOLPH RD
WHEATON MD
20902-1054
US

IV. Provider business mailing address

4011 RANDOLPH RD
WHEATON MD
20902-1054
US

V. Phone/Fax

Practice location:
  • Phone: 301-933-2500
  • Fax: 301-942-6992
Mailing address:
  • Phone: 301-933-2500
  • Fax: 301-942-6992

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number16255
License Number StateMD

VIII. Authorized Official

Name: MS. JUNG H. LEE
Title or Position: OWNER
Credential: LNHA
Phone: 301-933-2500