Healthcare Provider Details

I. General information

NPI: 1346834124
Provider Name (Legal Business Name): HEAL REST ASSISTED LIVING CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/23/2021
Last Update Date: 02/23/2021
Certification Date: 02/23/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 MAJOR KING LN
FORT WASHINGTON MD
20744-4795
US

IV. Provider business mailing address

3632 YORKTOWN DR
WALDORF MD
20601-3004
US

V. Phone/Fax

Practice location:
  • Phone: 240-816-0060
  • Fax:
Mailing address:
  • Phone: 240-816-0060
  • Fax: 240-816-0061

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: MS. ANDREA DEDIER
Title or Position: OWNER
Credential:
Phone: 240-354-3444