Provider Demographics
NPI:1508028572
Name:PAYNE MEMORIAL OUTREACH, INC.
Entity Type:Organization
Organization Name:PAYNE MEMORIAL OUTREACH, INC.
Other - Org Name:GOLDEN DOVES SENIOR MEDICAL DAY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:ESTHER
Authorized Official - Middle Name:
Authorized Official - Last Name:OLIVER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-462-3802
Mailing Address - Street 1:1701 MADISON AVE
Mailing Address - Street 2:1ST FLOOR
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21217-3731
Mailing Address - Country:US
Mailing Address - Phone:410-462-3802
Mailing Address - Fax:410-728-4880
Practice Address - Street 1:1701 MADISON AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21217-3731
Practice Address - Country:US
Practice Address - Phone:410-462-3802
Practice Address - Fax:410-728-4880
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-06-30
Last Update Date:2009-05-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30-018261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care