Healthcare Provider Details

I. General information

NPI: 1265245518
Provider Name (Legal Business Name): MICHAEL ANTONIO RICHARDSON CNA/GNA
Entity Type: Individual
Gender: Male
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 01/30/2025
Last Update Date: 08/19/2026
Certification Date: 08/19/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5457 TWIN KNOLLS RD STE 300
COLUMBIA MD
21045-3296
US

IV. Provider business mailing address

5457 TWIN KNOLLS RD STE 300
COLUMBIA MD
21045-3296
US

V. Phone/Fax

Practice location:
  • Phone: 800-301-6326
  • Fax:
Mailing address:
  • Phone: 800-799-8089
  • Fax: 361-310-3173

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberA00062099
License Number StateMD

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: