Healthcare Provider Details

I. General information

NPI: 1871124495
Provider Name (Legal Business Name): ENFIELD LOCKE CARE RESOURCES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/01/2020
Last Update Date: 02/01/2020
Certification Date: 02/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5929 CARROLL ST
GWYNN OAK MD
21207-3903
US

IV. Provider business mailing address

5929 CARROLL ST
GWYNN OAK MD
21207-3903
US

V. Phone/Fax

Practice location:
  • Phone: 443-558-6938
  • Fax: 443-327-4613
Mailing address:
  • Phone: 443-558-6938
  • Fax: 443-327-4613

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. TEMIDAYO A OGUNDIRAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 443-558-6938