Healthcare Provider Details

I. General information

NPI: 1457102261
Provider Name (Legal Business Name): KROWNE HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/29/2024
Last Update Date: 04/02/2024
Certification Date: 04/02/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5513 TWIN KNOLLS RD STE 213
COLUMBIA MD
21045-3264
US

IV. Provider business mailing address

5513 TWIN KNOLLS RD STE 213
COLUMBIA MD
21045-3264
US

V. Phone/Fax

Practice location:
  • Phone: 240-636-7405
  • Fax:
Mailing address:
  • Phone: 240-636-7405
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code208000000X
TaxonomyPediatrics Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: ADISATU ADEYEMI
Title or Position: DIRECTOR
Credential:
Phone: 240-636-7405