Healthcare Provider Details

I. General information

NPI: 1518721042
Provider Name (Legal Business Name): EXPRESS HOME & RENAL HEALTHCARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/06/2024
Last Update Date: 08/10/2026
Certification Date: 08/10/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 CONNECTICUT AVE STE 603
KENSINGTON MD
20895-3945
US

IV. Provider business mailing address

10400 CONNECTICUT AVE STE 603
KENSINGTON MD
20895-3945
US

V. Phone/Fax

Practice location:
  • Phone: 301-825-5900
  • Fax: 301-825-5888
Mailing address:
  • Phone: 301-825-5900
  • Fax: 301-825-5888

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: SOLOMON M FON
Title or Position: CEO/ADMINISTRATOR
Credential: CPA
Phone: 301-825-5900