Healthcare Provider Details

I. General information

NPI: 1043815004
Provider Name (Legal Business Name): ME FIRST RESPITE CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2020
Last Update Date: 12/01/2020
Certification Date: 12/01/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6703 REDFIELD AVE
HYATTSVILLE MD
20784-1436
US

IV. Provider business mailing address

6703 REDFIELD AVE
HYATTSVILLE MD
20784-1436
US

V. Phone/Fax

Practice location:
  • Phone: 301-747-3961
  • Fax:
Mailing address:
  • Phone: 301-747-3961
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code372600000X
TaxonomyAdult Companion
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. KEVIN PENDERGRASS SR.
Title or Position: CHIEF OPERATIONS OFFICER
Credential:
Phone: 301-747-3961