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General NPI Number Information
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NPI Number | 1508028572
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Entity Type | Organization
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Legal Business Name | PAYNE MEMORIAL OUTREACH, INC.
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 05/21/2009
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Provider Practice Location Address
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Address Line | 1701 MADISON AVE
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City | BALTIMORE
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State | MD
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Zip | 21217-3731
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Country | US
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Telephone | 410-462-3802
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Fax | 410-728-4880
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Provider Business Mailing Address
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Address Line | 1701 MADISON AVE 1ST FLOOR
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City | BALTIMORE
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State | MD
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Zip | 21217-3731
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Country | US
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Telephone | 410-462-3802
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Fax | 410-728-4880
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Authorized Official
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Title or Position | DIRECTOR
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Name | MS. ESTHER OLIVER
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Credential |
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Telephone | 410-462-3802
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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 | 30-018
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License Number State | MD
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