=====================================================
General NPI Number Information
=====================================================
NPI Number | 1508086653
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ADVENTURES ONE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 04/30/2007
-----------------------------------------------------
Last Update Date | 06/23/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 7121 OLD ALEXANDRIA FERRY RD
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-856-5553
-----------------------------------------------------
Fax | 301-856-5512
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 7121 OLD ALEXANDRIA FERRY RD
-----------------------------------------------------
City | CLINTON
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20735
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-856-5553
-----------------------------------------------------
Fax | 301-856-5512
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | EXECUTIVE DIRECTOR
-----------------------------------------------------
Name | ELEANOR L BONNER
-----------------------------------------------------
Credential | MS RN
-----------------------------------------------------
Telephone | 301-856-5553
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number | 11714
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------