Healthcare Provider Details

I. General information

NPI: 1275860447
Provider Name (Legal Business Name): GIG HOME HEALTH CARE AGENCY, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/09/2009
Last Update Date: 11/09/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11540 PROSPECT HILL RD
GLENN DALE MD
20769-9469
US

IV. Provider business mailing address

11540 PROSPECT HILL RD
GLENN DALE MD
20769-9469
US

V. Phone/Fax

Practice location:
  • Phone: 301-768-6060
  • Fax: 301-358-3883
Mailing address:
  • Phone: 301-768-6060
  • Fax: 301-358-3883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR2809P
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number080401
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number0803001
License Number StateMD

VIII. Authorized Official

Name: CORDELIA ADA NWAGBO
Title or Position: DON
Credential: RN
Phone: 240-899-3331