Provider Demographics
NPI:1851605687
Name:ST. MARY'S ADULT MEDICAL DAY CARE
Entity Type:Organization
Organization Name:ST. MARY'S ADULT MEDICAL DAY CARE
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:DEVADOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-298-9800
Mailing Address - Street 1:24400 MERVELL DEAN RD
Mailing Address - Street 2:
Mailing Address - City:HOLLYWOOD
Mailing Address - State:MD
Mailing Address - Zip Code:20636-2709
Mailing Address - Country:US
Mailing Address - Phone:301-373-6515
Mailing Address - Fax:301-373-6517
Practice Address - Street 1:24400 MERVELL DEAN RD
Practice Address - Street 2:
Practice Address - City:HOLLYWOOD
Practice Address - State:MD
Practice Address - Zip Code:20636-2709
Practice Address - Country:US
Practice Address - Phone:301-373-6515
Practice Address - Fax:301-373-6517
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-08-04
Last Update Date:2010-08-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD18-001-A261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care