Healthcare Provider Details

I. General information

NPI: 1255181160
Provider Name (Legal Business Name): IMPECCABLE HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2024
Last Update Date: 10/12/2024
Certification Date: 10/12/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9420 ANNAPOLIS RD STE 200
LANHAM MD
20706-3062
US

IV. Provider business mailing address

13209 AILESBURY CT UPPR MARLBORO
UPPER MARLBORO MD
20772-6100
US

V. Phone/Fax

Practice location:
  • Phone: 301-323-5124
  • Fax:
Mailing address:
  • Phone: 301-323-5124
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QR0401X
TaxonomyComprehensive Outpatient Rehabilitation Facility (CORF)
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MRS. RANTI OLUBUKOLA OKE
Title or Position: DIRECTOR OF OPERATION
Credential:
Phone: 301-323-5124