Provider Demographics
NPI:1770909871
Name:MEDCLUB ADULT DAY CARE
Entity type:Organization
Organization Name:MEDCLUB ADULT DAY CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:SAMIA
Authorized Official - Middle Name:
Authorized Official - Last Name:EL BAROUDY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-935-0045
Mailing Address - Street 1:5610 HARFORD RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21214-2247
Mailing Address - Country:US
Mailing Address - Phone:410-254-3000
Mailing Address - Fax:
Practice Address - Street 1:5610 HARFORD RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21214-2247
Practice Address - Country:US
Practice Address - Phone:410-254-3000
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-13
Last Update Date:2014-03-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD30025A261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care