MEDICARE: MONTGOMERY ADULT DAY CARE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QA0600X	Adult Day Care Clinic/Center

General Provider Information

NPI Number	:	1013318229
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MONTGOMERY ADULT DAY CARE, INC.

Provider Business Mailing Address
First Line	:	9123 GAITHER RD
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-1451
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	9123 GAITHER RD
Second Line	:
City	:	GAITHERSBURG
State	:	MD
Zip	:	20877-1451
Country	:	US
Telephone Number	:	240-423-9182
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	IRENE MAYZEL
Credential	:
Telephone Number	:	240-423-9182

Provider Enumeration Date	:	09/07/2014
Last Update Date	:	09/07/2014

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