MEDICARE: MOVEABLE FEAST

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	332U00000X	Home Delivered Meals	332U00000X	MD

General Provider Information

NPI Number	:	1982078044
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MOVEABLE FEAST

Provider Business Mailing Address
First Line	:	901 N MILTON AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21205-1316
Country	:	US
Telephone Number	:	410-327-3420
Fax Number	:	410-327-3426

Provider Business Practice Location Address
First Line	:	901 N MILTON AVE
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21205-1316
Country	:	US
Telephone Number	:	410-327-3420
Fax Number	:	410-327-3426

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MR. THOMAS BONDERENKO
Credential	:
Telephone Number	:	410-327-3420

Provider Enumeration Date	:	11/30/2015
Last Update Date	:	11/30/2015

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Directions to “MOVEABLE FEAST ” Practice Location

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