Provider Demographics
NPI:1538503404
Name:ADVANCE ADULT DAY CARE L.L.C.
Entity Type:Organization
Organization Name:ADVANCE ADULT DAY CARE L.L.C.
Other - Org Name:FRIENDSHIP ADULT MEDICAL DAY CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT/FACILITY DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:YEDUARD
Authorized Official - Middle Name:
Authorized Official - Last Name:PASTUSHENKO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-580-2040
Mailing Address - Street 1:1328 REISTERSTOWN RD
Mailing Address - Street 2:SUITE C
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-6503
Mailing Address - Country:US
Mailing Address - Phone:410-580-2040
Mailing Address - Fax:410-580-2060
Practice Address - Street 1:6255 KENWOOD AVE
Practice Address - Street 2:SUITE C
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21237-2036
Practice Address - Country:US
Practice Address - Phone:410-866-3700
Practice Address - Fax:410-866-5776
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-23
Last Update Date:2017-01-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD03-008-A261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD421663600Medicaid