Healthcare Provider Details

I. General information

NPI: 1144149477
Provider Name (Legal Business Name): SILOAM HEALTH SUPPORT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2026
Last Update Date: 07/11/2026
Certification Date: 07/12/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2936 BUCKTHORN CT
GLENARDEN MD
20706-5517
US

IV. Provider business mailing address

2936 BUCKTHORN CT
GLENARDEN MD
20706-5517
US

V. Phone/Fax

Practice location:
  • Phone: 431-997-7220
  • Fax: 800-948-9107
Mailing address:
  • Phone: 431-997-7220
  • Fax: 800-948-9107

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code320600000X
TaxonomyIntellectual and/or Developmental Disabilities Residential Treatment Facility
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: DR. ADENIYI A ADEGBESAN
Title or Position: CEO
Credential: MEDICAL DOCTOR
Phone: 431-997-7220