MEDICARE: ADULT DAY HEALTH, 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	311Z00000X	Custodial Care Facility

General Provider Information

NPI Number	:	1346600012
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ADULT DAY HEALTH, INC.

Provider Business Mailing Address
First Line	:	313 CONGRESS ST
Second Line	:
City	:	BOSTON
State	:	MA
Zip	:	02210-1218
Country	:	US
Telephone Number	:	781-326-0489
Fax Number	:

Provider Business Practice Location Address
First Line	:	1915 MARYLAND AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21218-5916
Country	:	US
Telephone Number	:	410-528-8730
Fax Number	:

Authorized Official
Title or Position	:	CFO
Name	:	MR. EDWARD DONAHUE
Credential	:
Telephone Number	:	781-326-0489

Provider Enumeration Date	:	02/24/2016
Last Update Date	:	02/24/2016

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