Healthcare Provider Details

I. General information

NPI: 1750908133
Provider Name (Legal Business Name): ACTIVITIES ADULT MEDICAL DAYCARE LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/01/2020
Last Update Date: 10/23/2023
Certification Date: 10/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2622 LORD BALTIMORE DR STE A
WINDSOR MILL MD
21244-2639
US

IV. Provider business mailing address

2622 LORD BALTIMORE DR STE A
WINDSOR MILL MD
21244-2639
US

V. Phone/Fax

Practice location:
  • Phone: 443-629-0696
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QP2000X
TaxonomyPhysical Therapy Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ASYA BUSSIE
Title or Position: OWNER
Credential:
Phone: 443-629-0696