Healthcare Provider Details

I. General information

NPI: 1609267269
Provider Name (Legal Business Name): SISTER MARYAM HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2015
Last Update Date: 02/18/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4110 AMES ST NE 14
WASHINGTON DC
20019-3309
US

IV. Provider business mailing address

13999 OLD COLUMBIA PIKE
SILVER SPRING MD
20904-4557
US

V. Phone/Fax

Practice location:
  • Phone: 202-352-1510
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateMD

VIII. Authorized Official

Name: SALIMAH HIPPS
Title or Position: FOUNDER
Credential:
Phone: 202-352-1510