Provider Demographics
NPI:1700556222
Name:EVISION MEDICAL ADULT DAY CENTER CORPORATION
Entity Type:Organization
Organization Name:EVISION MEDICAL ADULT DAY CENTER CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SHALITA
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-739-2084
Mailing Address - Street 1:4806 MANTLEWOOD WAY APT 102
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-3646
Mailing Address - Country:US
Mailing Address - Phone:443-739-2084
Mailing Address - Fax:
Practice Address - Street 1:100 S. TAYLOR AVE
Practice Address - Street 2:
Practice Address - City:ESSEX
Practice Address - State:MD
Practice Address - Zip Code:21221
Practice Address - Country:US
Practice Address - Phone:443-739-2084
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-16
Last Update Date:2021-09-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2188G72MOtherMEDICARE, MEDICAID, MEDICAL ASSISTANCE, PRIVATE PAYER