Provider Demographics
NPI:1154192961
Name:DACOTA ASSISTED LIVING
Entity type:Organization
Organization Name:DACOTA ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:MARK
Authorized Official - Middle Name:
Authorized Official - Last Name:DIDOMENICO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-575-7772
Mailing Address - Street 1:468 W BEL AIR AVE
Mailing Address - Street 2:
Mailing Address - City:ABERDEEN
Mailing Address - State:MD
Mailing Address - Zip Code:21001-2425
Mailing Address - Country:US
Mailing Address - Phone:410-575-7772
Mailing Address - Fax:410-272-2525
Practice Address - Street 1:468 W BEL AIR AVE
Practice Address - Street 2:
Practice Address - City:ABERDEEN
Practice Address - State:MD
Practice Address - Zip Code:21001-2425
Practice Address - Country:US
Practice Address - Phone:410-575-7772
Practice Address - Fax:410-272-2525
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-10
Last Update Date:2024-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility