Provider Demographics
NPI:1689715526
Name:ACTIVE DAY MD, INC.
Entity Type:Organization
Organization Name:ACTIVE DAY MD, INC.
Other - Org Name:ACTIVE DAY OF DUNDALK
Other - Org Type:Doing Business As
Authorized Official - Title/Position:COO
Authorized Official - Prefix:
Authorized Official - First Name:CRAIG
Authorized Official - Middle Name:
Authorized Official - Last Name:MEHNERT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:215-642-6600
Mailing Address - Street 1:7 NESHAMINY INTERPLEX DR
Mailing Address - Street 2:SUITE 403
Mailing Address - City:TREVOSE
Mailing Address - State:PA
Mailing Address - Zip Code:19053-6927
Mailing Address - Country:US
Mailing Address - Phone:215-642-6600
Mailing Address - Fax:215-642-6610
Practice Address - Street 1:1730 MERRITT BLVD
Practice Address - Street 2:
Practice Address - City:DUNDALK
Practice Address - State:MD
Practice Address - Zip Code:21222-3212
Practice Address - Country:US
Practice Address - Phone:410-282-2756
Practice Address - Fax:410-282-3569
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIVE DAY, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-02-12
Last Update Date:2011-12-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD408431400Medicaid