Healthcare Provider Details

I. General information

NPI: 1003368804
Provider Name (Legal Business Name): ADVANCED HEALTH PROS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/27/2016
Last Update Date: 10/27/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3527 N ROLLING RD SUITE 21
BALTIMORE MD
21244-2223
US

IV. Provider business mailing address

3527 N ROLLING RD SUITE 21
BALTIMORE MD
21244-2223
US

V. Phone/Fax

Practice location:
  • Phone: 410-655-1202
  • Fax:
Mailing address:
  • Phone: 410-655-1202
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberR2228
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberR2228
License Number StateMD

VIII. Authorized Official

Name: MR. QUADRI JOHNSON
Title or Position: DIRECTOR
Credential:
Phone: 410-655-1202