Healthcare Provider Details

I. General information

NPI: 1235848052
Provider Name (Legal Business Name): ULTIMA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/21/2022
Last Update Date: 11/21/2022
Certification Date: 11/14/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10320 LITTLE PATUXENT PKWY STE 200
COLUMBIA MD
21044-3344
US

IV. Provider business mailing address

2851 JESSUP RD UNIT 932
JESSUP MD
20794-7545
US

V. Phone/Fax

Practice location:
  • Phone: 833-693-0833
  • Fax: 410-429-2968
Mailing address:
  • Phone: 833-693-0833
  • Fax: 410-429-2968

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code332900000X
TaxonomyNon-Pharmacy Dispensing Site
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332B00000X
TaxonomyDurable Medical Equipment & Medical Supplies
License Number
License Number State

VIII. Authorized Official

Name: K.C. GLEATON
Title or Position: OWNER
Credential:
Phone: 410-999-0999