Provider Demographics
NPI:1316167521
Name:ADULT DAY CARE OF CALVERT COUNTY
Entity type:Organization
Organization Name:ADULT DAY CARE OF CALVERT COUNTY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:LISA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOCHELL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-535-0133
Mailing Address - Street 1:PO BOX 1659
Mailing Address - Street 2:
Mailing Address - City:PRINCE FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:20678-1659
Mailing Address - Country:US
Mailing Address - Phone:410-535-0133
Mailing Address - Fax:410-535-4094
Practice Address - Street 1:975 SOLOMONS ISLAND ROAD
Practice Address - Street 2:
Practice Address - City:PRINCE FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:20678
Practice Address - Country:US
Practice Address - Phone:410-535-0133
Practice Address - Fax:410-535-4094
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-04-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD9145261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care