Provider Demographics
NPI:1720382708
Name:ST. JOHN THE BAPTIST ADULT MED. DAYCARE
Entity Type:Organization
Organization Name:ST. JOHN THE BAPTIST ADULT MED. DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:E
Authorized Official - Last Name:DEVEDOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-298-9800
Mailing Address - Street 1:10947 GOLDEN WEST DR
Mailing Address - Street 2:STE 200
Mailing Address - City:HUNT VALLEY
Mailing Address - State:MD
Mailing Address - Zip Code:21031-1312
Mailing Address - Country:US
Mailing Address - Phone:410-329-1444
Mailing Address - Fax:410-329-1533
Practice Address - Street 1:10947 GOLDEN WEST DR
Practice Address - Street 2:STE 200
Practice Address - City:HUNT VALLEY
Practice Address - State:MD
Practice Address - Zip Code:21031-1312
Practice Address - Country:US
Practice Address - Phone:410-329-1444
Practice Address - Fax:410-329-1533
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-01-05
Last Update Date:2011-01-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care