Healthcare Provider Details

I. General information

NPI: 1841041563
Provider Name (Legal Business Name): MONTGOMERY ADULT DAILY LIVING CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 03/29/2024
Certification Date: 03/29/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

621 COWPATH RD
LANSDALE PA
19446-1503
US

IV. Provider business mailing address

621 COWPATH RD
LANSDALE PA
19446-1503
US

V. Phone/Fax

Practice location:
  • Phone: 215-855-7997
  • Fax:
Mailing address:
  • Phone: 215-855-7997
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JUNG SOE
Title or Position: DIRECTOR / OWNER
Credential:
Phone: 267-626-4989