Provider Demographics
NPI:1396882346
Name:PIKESVILLE ADULT DAY CARE
Entity type:Organization
Organization Name:PIKESVILLE ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ASSIST DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:CLEVELAND
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-601-2935
Mailing Address - Street 1:2434 W BELVEDERE AVE
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21215-5202
Mailing Address - Country:US
Mailing Address - Phone:410-466-8700
Mailing Address - Fax:
Practice Address - Street 1:133 SLADE AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21208-4907
Practice Address - Country:US
Practice Address - Phone:410-653-3933
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-31
Last Update Date:2008-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD0575261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD272753600Medicaid
MD272753600Medicaid