Provider Demographics
NPI:1386837656
Name:SUPERIOR ADULT MEDICAL DAY SERVICES, LLC
Entity Type:Organization
Organization Name:SUPERIOR ADULT MEDICAL DAY SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:SIMONE
Authorized Official - Middle Name:
Authorized Official - Last Name:GALLETTA
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:856-507-1911
Mailing Address - Street 1:9946 LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-1804
Mailing Address - Country:US
Mailing Address - Phone:410-496-6220
Mailing Address - Fax:410-496-6221
Practice Address - Street 1:9946 LIBERTY RD
Practice Address - Street 2:
Practice Address - City:RANDALLSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21133-1804
Practice Address - Country:US
Practice Address - Phone:410-496-6220
Practice Address - Fax:410-496-6221
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-08-21
Last Update Date:2007-08-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD00000000000261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care