Healthcare Provider Details

I. General information

NPI: 1881530236
Provider Name (Legal Business Name): PASSIONATE RESIDENTIAL HEALTH SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/28/2026
Last Update Date: 04/28/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2700 LOCH RAVEN RD
BALTIMORE MD
21218-4729
US

IV. Provider business mailing address

2700 LOCH RAVEN RD
BALTIMORE MD
21218-4729
US

V. Phone/Fax

Practice location:
  • Phone: 667-405-6548
  • Fax:
Mailing address:
  • Phone: 667-405-6548
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State

VIII. Authorized Official

Name: FULAI DIOM
Title or Position: COO
Credential:
Phone: 667-405-6548