MEDICARE: PALLADIUM 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	:	1376128470
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	PALLADIUM ADULT DAY CARE, INC.

Provider Business Mailing Address
First Line	:	9673 63RD AVE N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-6253
Country	:	US
Telephone Number	:	612-296-8931
Fax Number	:

Provider Business Practice Location Address
First Line	:	9673 63RD AVE N
Second Line	:
City	:	MAPLE GROVE
State	:	MN
Zip	:	55369-6253
Country	:	US
Telephone Number	:	612-296-8931
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	NELLA MALOYLO
Credential	:
Telephone Number	:	612-296-8931

Provider Enumeration Date	:	03/10/2021
Last Update Date	:	03/10/2021

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