=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811278443
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | TEAM 3 INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/09/2011
-----------------------------------------------------
Last Update Date | 09/09/2011
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9075 GUILFORD RD
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21046-3145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-276-3088
-----------------------------------------------------
Fax | 443-276-3095
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 9075 GUILFORD RD
-----------------------------------------------------
City | COLUMBIA
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21046-3145
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-276-3088
-----------------------------------------------------
Fax | 443-276-3095
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MR. ERIC RAKHAMIMOV
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 443-220-5356
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QA0600X
-----------------------------------------------------
Taxonomy Name | Adult Day Care Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------