Healthcare Provider Details

I. General information

NPI: 1821818253
Provider Name (Legal Business Name): QUMOLZ HEALTHCARE INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/11/2024
Last Update Date: 10/11/2024
Certification Date: 10/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5205 EAST DR STE H
HALETHORPE MD
21227-2403
US

IV. Provider business mailing address

5205 EAST DR STE H
HALETHORPE MD
21227-2403
US

V. Phone/Fax

Practice location:
  • Phone: 443-631-4318
  • Fax:
Mailing address:
  • Phone: 443-631-4318
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: HELEN TINUKE KUMOLALO
Title or Position: CEO
Credential:
Phone: 443-631-4318