Healthcare Provider Details

I. General information

NPI: 1568344000
Provider Name (Legal Business Name): TETE ROLLING HILLS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/24/2025
Last Update Date: 07/24/2025
Certification Date: 07/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

309 COURT AVE # 891
DES MOINES IA
50309-2245
US

IV. Provider business mailing address

7700 OLD BRANCH AVE STE B201
CLINTON MD
20735-1605
US

V. Phone/Fax

Practice location:
  • Phone: 202-751-0232
  • Fax:
Mailing address:
  • Phone: 202-751-0232
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JUNIOR MBUA LAMBUA
Title or Position: ADMINISTRATION
Credential:
Phone: 202-751-0232