Provider Demographics
NPI:1104152594
Name:HERITAGE ADULT DAYCARE INC
Entity type:Organization
Organization Name:HERITAGE ADULT DAYCARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DANIEL
Authorized Official - Middle Name:
Authorized Official - Last Name:TROSMAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-825-5575
Mailing Address - Street 1:304 REISTERSTOWN RD
Mailing Address - Street 2:
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5312
Mailing Address - Country:US
Mailing Address - Phone:410-825-5575
Mailing Address - Fax:410-825-5578
Practice Address - Street 1:8240 LOCH RAVEN BLVD
Practice Address - Street 2:
Practice Address - City:TOWSON
Practice Address - State:MD
Practice Address - Zip Code:21286-8200
Practice Address - Country:US
Practice Address - Phone:410-825-5575
Practice Address - Fax:410-825-5578
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-10-20
Last Update Date:2009-11-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD417975700Medicaid