Provider Demographics
NPI:1801277520
Name:ADULLUM COMMUNITY HEALTHCARE CENTER, INC.
Entity type:Organization
Organization Name:ADULLUM COMMUNITY HEALTHCARE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/MEDICAL DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:IRANCE
Authorized Official - Middle Name:
Authorized Official - Last Name:REDDIX
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:318-348-5622
Mailing Address - Street 1:3317 KENJAC RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-1323
Mailing Address - Country:US
Mailing Address - Phone:318-348-5622
Mailing Address - Fax:
Practice Address - Street 1:644 E 33RD ST
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21218-3504
Practice Address - Country:US
Practice Address - Phone:318-348-5622
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-18
Last Update Date:2022-05-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center