Provider Demographics
NPI:1437519121
Name:ADULT DAY HEALTH, INC.
Entity Type:Organization
Organization Name:ADULT DAY HEALTH, INC.
Other - Org Name:LONG LIFE ADULT DAY CARE CENTER
Other - Org Type:Other Name
Authorized Official - Title/Position:VP QUALITY IMPROVEMENT
Authorized Official - Prefix:
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:R
Authorized Official - Last Name:REDD-GARCELON
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:508-618-7952
Mailing Address - Street 1:225 FOXBOROUGH BLVD STE 103
Mailing Address - Street 2:
Mailing Address - City:FOXBOROUGH
Mailing Address - State:MA
Mailing Address - Zip Code:02035-3062
Mailing Address - Country:US
Mailing Address - Phone:508-618-7952
Mailing Address - Fax:774-215-5708
Practice Address - Street 1:9075 GUILFORD RD
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3145
Practice Address - Country:US
Practice Address - Phone:443-276-3088
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-02-24
Last Update Date:2023-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD13-009OtherSTATE OPERATING LICENSE
MD21D2029565OtherCLIA