Healthcare Provider Details

I. General information

NPI: 1811829062
Provider Name (Legal Business Name): PERFORMANCE HEALTH GROUP LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2026
Last Update Date: 06/02/2026
Certification Date: 06/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

614 NESBITT RD
COLORA MD
21917-1110
US

IV. Provider business mailing address

614 NESBITT RD
COLORA MD
21917-1110
US

V. Phone/Fax

Practice location:
  • Phone: 302-561-2651
  • Fax:
Mailing address:
  • Phone: 302-561-2651
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: JAVIN TAYLOR
Title or Position: OWNER
Credential: RN
Phone: 302-561-2651