1538503404 NPI number — ADVANCE ADULT DAY CARE L.L.C.

Table of content: (NPI 1538503404)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1538503404 NPI number — ADVANCE ADULT DAY CARE L.L.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ADVANCE ADULT DAY CARE L.L.C.
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
6
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1538503404
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/19/2017
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1328 REISTERSTOWN RD
Provider Second Line Business Mailing Address:
SUITE C
Provider Business Mailing Address City Name:
PIKESVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21208-6503
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-580-2040
Provider Business Mailing Address Fax Number:
410-580-2060

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
6255 KENWOOD AVE
Provider Second Line Business Practice Location Address:
SUITE C
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21237-2036
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-866-3700
Provider Business Practice Location Address Fax Number:
410-866-5776
Provider Enumeration Date:
04/23/2013

Additional Information

Authorized Official

Authorized Official Last Name:
PASTUSHENKO
Authorized Official First Name:
YEDUARD
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT/FACILITY DIRECTOR
Authorized Official Telephone Number:
410-580-2040

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X , with the licence number:  03-008-A , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 421663600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com