Healthcare Provider Details

I. General information

NPI: 1821755968
Provider Name (Legal Business Name): EXPRESS HOME & RENAL HEALTHCARE, LLC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/23/2021
Last Update Date: 11/23/2021
Certification Date: 11/08/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10400 CONNECTICUT AVE STE 602
KENSINGTON MD
20895-3909
US

IV. Provider business mailing address

10400 CONNECTICUT AVE STE 602
KENSINGTON MD
20895-3909
US

V. Phone/Fax

Practice location:
  • Phone: 301-704-2667
  • Fax: 301-649-2109
Mailing address:
  • Phone: 301-704-2667
  • Fax: 301-649-2109

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 Code251F00000X
TaxonomyHome Infusion Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code385HR2065X
TaxonomyChild Physical Disabilities Respite Care
License Number
License Number State

VIII. Authorized Official

Name: MR. SOLOMON M FON
Title or Position: CEO/ADMINISTRATOR
Credential: CPA
Phone: 301-704-2667