Healthcare Provider Details

I. General information

NPI: 1700212057
Provider Name (Legal Business Name): GREAT EXPECTATIONS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2013
Last Update Date: 03/28/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6490 LANDOVER RD SUITE D ROOM #6
CHEVERLY MD
20785-1443
US

IV. Provider business mailing address

6490 LANDOVER RD SUITE D ROOM #6
CHEVERLY MD
20785
US

V. Phone/Fax

Practice location:
  • Phone: 301-200-8010
  • Fax: 301-841-8016
Mailing address:
  • Phone: 301-200-8010
  • Fax: 301-841-8016

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberHCO171179
License Number StateVA
# 2
Primary TaxonomyN
Taxonomy Code163WC2100X
TaxonomyContinence Care Registered Nurse
License NumberHCO171179
License Number StateVA
# 3
Primary TaxonomyN
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License NumberHCO171179
License Number StateVA
# 4
Primary TaxonomyN
Taxonomy Code163WP0200X
TaxonomyPediatric Registered Nurse
License NumberHCO171179
License Number StateVA
# 5
Primary TaxonomyN
Taxonomy Code163WW0000X
TaxonomyWound Care Registered Nurse
License NumberHCO171179
License Number StateVA
# 6
Primary TaxonomyN
Taxonomy Code164W00000X
TaxonomyLicensed Practical Nurse
License NumberHCO171179
License Number StateVA
# 7
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License NumberHCO181179
License Number StateVA
# 8
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number130702
License Number StateMD
# 9
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number130702
License Number StateMD
# 10
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number130702
License Number StateMD
# 11
Primary TaxonomyN
Taxonomy Code251F00000X
TaxonomyHome Infusion Agency
License Number130702
License Number StateMD
# 12
Primary TaxonomyN
Taxonomy Code252Y00000X
TaxonomyEarly Intervention Provider Agency
License NumberHCO171179
License Number StateVA
# 13
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number130702
License Number StateMD
# 14
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number130702
License Number StateMD
# 15
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number130702
License Number StateMD

VIII. Authorized Official

Name: MR. ABRAHAM KOROMA
Title or Position: ADMINISTRATOR
Credential:
Phone: 301-200-8010