Healthcare Provider Details

I. General information

NPI: 1104786623
Provider Name (Legal Business Name): 1844 HAWK CT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2025
Last Update Date: 11/17/2025
Certification Date: 11/17/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2411 CROFTON LN # 24
CROFTON MD
21114-1304
US

IV. Provider business mailing address

1121 ANNAPOLIS RD
ODENTON MD
21113-1633
US

V. Phone/Fax

Practice location:
  • Phone: 667-450-2727
  • Fax: 667-450-2727
Mailing address:
  • Phone: 667-656-7707
  • Fax: 443-308-2118

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State

VIII. Authorized Official

Name: PATRICEO B GREEN
Title or Position: BRAND AWARENESS MANAGER
Credential:
Phone: 667-450-2727