Provider Demographics
NPI:1427199918
Name:ALICE MANOR ADULT DAYCARE
Entity type:Organization
Organization Name:ALICE MANOR ADULT DAYCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:JOSEPH
Authorized Official - Middle Name:EDWARD
Authorized Official - Last Name:DEVADOSS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-298-9800
Mailing Address - Street 1:6401 DOGWOOD RD STE 108
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21207-5248
Mailing Address - Country:US
Mailing Address - Phone:410-298-9800
Mailing Address - Fax:410-298-5206
Practice Address - Street 1:6401 DOGWOOD RD STE 101
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21207-5248
Practice Address - Country:US
Practice Address - Phone:410-298-7255
Practice Address - Fax:410-298-5850
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-09
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care