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General NPI Number Information
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NPI Number | 1912681883
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Entity Type | Organization
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Legal Business Name | VITALITY 360 OF BALTIMORE AT PROVIDENCE
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Dates
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Enumeration Date | 06/12/2023
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Last Update Date | 06/12/2023
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Provider Practice Location Address
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Address Line | 1427 PENNSYLVANIA AVE
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City | BALTIMORE
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State | MD
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Zip | 21217-3135
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Country | US
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Telephone | 443-606-6424
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Fax |
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Provider Business Mailing Address
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Address Line | 4001 SEVEN MILE LN
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City | PIKESVILLE
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State | MD
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Zip | 21208-6114
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | CHIMERE BECOTE
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Credential |
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Telephone | 443-606-6424
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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 |
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License Number State |
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