Provider Demographics
NPI:1730337304
Name:CCACC ADULT DAY HEALTHCARE CENTER
Entity type:Organization
Organization Name:CCACC ADULT DAY HEALTHCARE CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CENTER DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:NED
Authorized Official - Middle Name:
Authorized Official - Last Name:LI
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-820-7188
Mailing Address - Street 1:9366 GAITHER RD
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-1416
Mailing Address - Country:US
Mailing Address - Phone:301-820-7200
Mailing Address - Fax:240-823-6060
Practice Address - Street 1:9366 GAITHER RD
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-1416
Practice Address - Country:US
Practice Address - Phone:301-820-7200
Practice Address - Fax:240-823-6060
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:CHINESE CULTURE AND COMMUNITY SERVICE CENTER, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-09-08
Last Update Date:2015-04-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care