Healthcare Provider Details

I. General information

NPI: 1326452228
Provider Name (Legal Business Name): NEW LIFE ADULT MEDICAL DAY CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/18/2014
Last Update Date: 06/18/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7600 CLAYS LN
WINDSOR MILL MD
21244-2003
US

IV. Provider business mailing address

7600 CLAYS LN
WINDSOR MILL MD
21244-2003
US

V. Phone/Fax

Practice location:
  • Phone: 410-944-1002
  • Fax:
Mailing address:
  • Phone: 410-944-1002
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number30028A
License Number StateMD

VIII. Authorized Official

Name: MR. SYED FARHAT
Title or Position: MANAGER
Credential:
Phone: 410-944-1002