Healthcare Provider Details

I. General information

NPI: 1619554144
Provider Name (Legal Business Name): ADRA GENERAL SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2021
Last Update Date: 03/29/2021
Certification Date: 03/29/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13007 AUGUSTAS PROGRESS DRIVE
BOWIE MD
20720-6315
US

IV. Provider business mailing address

13007 AUGUSTAS PROGRESS DRIVE
BOWIE MD
20720-6315
US

V. Phone/Fax

Practice location:
  • Phone: 301-455-8198
  • Fax:
Mailing address:
  • Phone: 301-455-8198
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: MR. RASHEED JOHNSON
Title or Position: DIRECTOR
Credential: RPT
Phone: 301-455-8198