Provider Demographics
NPI:1487871463
Name:ADULT DAY SERVICES AT UNION HOSPITAL
Entity type:Organization
Organization Name:ADULT DAY SERVICES AT UNION HOSPITAL
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:CHARLOTTE
Authorized Official - Middle Name:
Authorized Official - Last Name:TEMPLE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:410-392-0539
Mailing Address - Street 1:301 AUGUSTINE HERMAN HWY
Mailing Address - Street 2:
Mailing Address - City:ELKTON
Mailing Address - State:MD
Mailing Address - Zip Code:21921-6587
Mailing Address - Country:US
Mailing Address - Phone:410-392-0539
Mailing Address - Fax:410-398-1838
Practice Address - Street 1:301 AUGUSTINE HERMAN HWY
Practice Address - Street 2:
Practice Address - City:ELKTON
Practice Address - State:MD
Practice Address - Zip Code:21921-6587
Practice Address - Country:US
Practice Address - Phone:410-392-0539
Practice Address - Fax:410-398-1838
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:UNION HOSPITAL OF CECIL COUNTY INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-04-19
Last Update Date:2018-03-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD17306261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD502533800Medicaid