MEDICARE: GOLDIE'S ADULT MEDICAL DAYCARE 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	:	1962111930
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	GOLDIE'S ADULT MEDICAL DAYCARE INC.

Provider Business Mailing Address
First Line	:	4328 RITCHIE HWY
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21225-2747
Country	:	US
Telephone Number	:	410-302-8700
Fax Number	:

Provider Business Practice Location Address
First Line	:	4328 RITCHIE HWY
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21225-2747
Country	:	US
Telephone Number	:	410-302-8700
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MR. MARC A RANDALL SR.
Credential	:
Telephone Number	:	410-302-8700

Provider Enumeration Date	:	11/18/2022
Last Update Date	:	11/18/2022

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