Provider Demographics
NPI:1679673693
Name:MILBROOK CIRCLE OF FRIENDS ADHC
Entity Type:Organization
Organization Name:MILBROOK CIRCLE OF FRIENDS ADHC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:ELLEN
Authorized Official - Middle Name:
Authorized Official - Last Name:VEZEL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-580-9099
Mailing Address - Street 1:4398 CREST HEIGHTS RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215
Mailing Address - Country:US
Mailing Address - Phone:410-580-9099
Mailing Address - Fax:410-580-9098
Practice Address - Street 1:4398 CREST HEIGHTS RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21215
Practice Address - Country:US
Practice Address - Phone:410-580-9099
Practice Address - Fax:410-580-9098
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-09-22
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care