Provider Demographics
NPI:1952509218
Name:DORCHESTER COUNTY COMMISSION ON THE AGING, INC
Entity Type:Organization
Organization Name:DORCHESTER COUNTY COMMISSION ON THE AGING, INC
Other - Org Name:PLEASANT DAY MEDICAL ADULT DAY CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:JACKIE
Authorized Official - Middle Name:J
Authorized Official - Last Name:VICKERS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-228-0190
Mailing Address - Street 1:2474 CAMBRIDGE BELTWAY
Mailing Address - Street 2:
Mailing Address - City:CAMBRIDGE
Mailing Address - State:MD
Mailing Address - Zip Code:21613-3679
Mailing Address - Country:US
Mailing Address - Phone:410-228-0190
Mailing Address - Fax:410-221-8064
Practice Address - Street 1:2474 CAMBRIDGE BELTWAY
Practice Address - Street 2:
Practice Address - City:CAMBRIDGE
Practice Address - State:MD
Practice Address - Zip Code:21613-3679
Practice Address - Country:US
Practice Address - Phone:410-228-0190
Practice Address - Fax:410-221-8064
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2023-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD273463000Medicaid