Healthcare Provider Details

I. General information

NPI: 1528378528
Provider Name (Legal Business Name): HIGHLY BLESSED HEALTHCARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/09/2010
Last Update Date: 10/09/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9251 LOTTSFORD RD APT 3D
LARGO MD
20774-3769
US

IV. Provider business mailing address

9251 LOTTSFORD RD APT 3D
LARGO MD
20774-3769
US

V. Phone/Fax

Practice location:
  • Phone: 240-988-2626
  • Fax: 301-350-3429
Mailing address:
  • Phone: 240-988-2626
  • Fax: 301-350-3429

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR2942P
License Number StateMD

VII. Legacy identifiers

For crosswalk purposes, the following legacy (non-NPI) identifiers are available for this provider:

VIII. Authorized Official

Name: DR. AKINJIDE DAVID AGBODO
Title or Position: PHARMACIST
Credential:
Phone: 240-988-2626