Provider Demographics
NPI:1023235157
Name:ST. MARY'S COUNTY GOV'T, DEPT. OF AGING, MEDICAL ADULT DAY SERVICES
Entity type:Organization
Organization Name:ST. MARY'S COUNTY GOV'T, DEPT. OF AGING, MEDICAL ADULT DAY SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR, DEPARTMENT OF AGING
Authorized Official - Prefix:
Authorized Official - First Name:LORI
Authorized Official - Middle Name:JENNINGS-
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-475-4200
Mailing Address - Street 1:PO BOX 653
Mailing Address - Street 2:
Mailing Address - City:LEONARDTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20650-0653
Mailing Address - Country:US
Mailing Address - Phone:301-475-4200
Mailing Address - Fax:301-475-4503
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:2007-04-19
Last Update Date:2007-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care