MEDICARE: GERMANTOWN ADULT DAY CENTER, 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	:	1932579307
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GERMANTOWN ADULT DAY CENTER, INC

Provider Business Mailing Address
First Line	:	1568B STONEY LN
Second Line	:
City	:	PHILADELPHIA
State	:	PA
Zip	:	19115-4279
Country	:	US
Telephone Number	:	267-992-3766
Fax Number	:

Provider Business Practice Location Address
First Line	:	4811 GERMANTOWN AVE
Second Line	:	BLDG D
City	:	PHILADELPHIA
State	:	PA
Zip	:	19144-3014
Country	:	US
Telephone Number	:	267-992-3766
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT
Name	:	VOLODYMYR LISOVYY
Credential	:
Telephone Number	:	267-992-3766

Provider Enumeration Date	:	09/29/2015
Last Update Date	:	09/29/2015

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