Provider Demographics
NPI:1386996262
Name:CHESTERWYE ADULT DAY MEDICAL CARE
Entity type:Organization
Organization Name:CHESTERWYE ADULT DAY MEDICAL CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DAN
Authorized Official - Middle Name:
Authorized Official - Last Name:BUNGORI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-249-3549
Mailing Address - Street 1:891 LOVE POINT RD
Mailing Address - Street 2:
Mailing Address - City:STEVENSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21666-2189
Mailing Address - Country:US
Mailing Address - Phone:443-249-3549
Mailing Address - Fax:410-827-6457
Practice Address - Street 1:891 LOVE POINT RD
Practice Address - Street 2:
Practice Address - City:STEVENSVILLE
Practice Address - State:MD
Practice Address - Zip Code:21666-2189
Practice Address - Country:US
Practice Address - Phone:443-249-3549
Practice Address - Fax:410-827-6457
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHESTERWYE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-10-03
Last Update Date:2012-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302R00000XManaged Care OrganizationsHealth Maintenance Organization