Healthcare Provider Details

I. General information

NPI: 1225940869
Provider Name (Legal Business Name): MARIE MONA HOME CARE SUPPORT LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/18/2026
Last Update Date: 09/18/2026
Certification Date: 09/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7912 PIEDMONT AVE
GLENARDEN MD
20706-1739
US

IV. Provider business mailing address

7912 PIEDMONT AVE
GLENARDEN MD
20706-1739
US

V. Phone/Fax

Practice location:
  • Phone: 301-732-9414
  • Fax:
Mailing address:
  • Phone: 301-732-9414
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code315P00000X
TaxonomyIntellectual Disabilities Intermediate Care Facility
License Number
License Number State

VIII. Authorized Official

Name: ALVIN RAYSHAWN PITTS
Title or Position: CEO
Credential:
Phone: 301-732-9414