Provider Demographics
NPI:1609690569
Name:ADVANCED CENTERS FOR THE SPECIALLY ENABLED LLC
Entity type:Organization
Organization Name:ADVANCED CENTERS FOR THE SPECIALLY ENABLED LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:RENE
Authorized Official - Middle Name:
Authorized Official - Last Name:PALACIOS
Authorized Official - Suffix:JR
Authorized Official - Credentials:
Authorized Official - Phone:410-777-9063
Mailing Address - Street 1:9125 GUILFORD RD STE 104
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-3459
Mailing Address - Country:US
Mailing Address - Phone:410-777-9063
Mailing Address - Fax:
Practice Address - Street 1:9125 GUILFORD RD STE 104
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-3459
Practice Address - Country:US
Practice Address - Phone:410-777-9063
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-11-08
Last Update Date:2024-11-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
No261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No385H00000XRespite Care FacilityRespite Care