Provider Demographics
NPI:1710105614
Name:ADOL ASSISTED LIVING
Entity Type:Organization
Organization Name:ADOL ASSISTED LIVING
Other - Org Name:ADOL ASSISTED LIVING PINE TREE HOUSE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:WUNMI
Authorized Official - Middle Name:
Authorized Official - Last Name:OLATUNDE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-442-9663
Mailing Address - Street 1:11209 BASSWOOD TER
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-3173
Mailing Address - Country:US
Mailing Address - Phone:301-442-9663
Mailing Address - Fax:301-776-2339
Practice Address - Street 1:4903 PLATA ST
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-2437
Practice Address - Country:US
Practice Address - Phone:301-297-7344
Practice Address - Fax:301-776-2339
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-23
Last Update Date:2007-09-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16AL0839310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility