Healthcare Provider Details

I. General information

NPI: 1700692092
Provider Name (Legal Business Name): OPENBLISS ADULT RESIDENTIAL LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/10/2024
Last Update Date: 12/10/2024
Certification Date: 12/10/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11401 ROLLING GREEN PL
HAGERSTOWN MD
21742-3165
US

IV. Provider business mailing address

11401 ROLLING GREEN PL
HAGERSTOWN MD
21742-3165
US

V. Phone/Fax

Practice location:
  • Phone: 301-256-1153
  • Fax:
Mailing address:
  • Phone: 301-256-1153
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: OLUWAKEMI S AKINRINBOLA
Title or Position: PMHNP
Credential: CRNP
Phone: 301-256-1153