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General NPI Number Information
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NPI Number | 1336686203
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Entity Type | Organization
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Legal Business Name | ADVANCE ADULT DAY CARE LLC
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Dates
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Enumeration Date | 01/30/2017
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Last Update Date | 01/30/2017
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Provider Practice Location Address
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Address Line | 3 EASTER CT STE. B
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City | OWINGS MILLS
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State | MD
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Zip | 21117-3297
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Country | US
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Telephone | 410-580-2040
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Fax | 410-580-2060
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Provider Business Mailing Address
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Address Line | 1328 REISTERSTOWN RD STE. C
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City | PIKESVILLE
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State | MD
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Zip | 21208-3838
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Country | US
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Telephone | 410-580-2040
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Fax | 410-580-2060
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Authorized Official
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Title or Position | PRESIDENT
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Name | YEDUARD PASTUSHENKO
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Credential |
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Telephone | 410-580-2040
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QA0600X
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Taxonomy Name | Adult Day Care Clinic/Center
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License Number | 03-027-A
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License Number State | MD
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