Healthcare Provider Details

I. General information

NPI: 1780588632
Provider Name (Legal Business Name): LONDONHOLLYWOOD HEALTH SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/05/2026
Last Update Date: 10/05/2026
Certification Date: 10/01/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1732 COPPERLEAF BLVD
HANOVER MD
21076
US

IV. Provider business mailing address

4870 SADLER RD STE 300
GLEN ALLEN VA
23060-6294
US

V. Phone/Fax

Practice location:
  • Phone: 301-806-3125
  • Fax:
Mailing address:
  • Phone: 301-806-3125
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL

VIII. Authorized Official

Name: CHARLOTTE A O'DELL
Title or Position: OWNER
Credential:
Phone: 301-806-3125