Healthcare Provider Details

I. General information

NPI: 1053879304
Provider Name (Legal Business Name): PROCEDRA, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2019
Last Update Date: 11/15/2019
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8101 SANDY SPRING RD
LAUREL MD
20707
US

IV. Provider business mailing address

8101 SANDY SPRING RD
LAUREL MD
20707-3596
US

V. Phone/Fax

Practice location:
  • Phone: 571-268-8720
  • Fax:
Mailing address:
  • Phone: 571-268-8720
  • Fax:

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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: AHMED AYODEJI
Title or Position: OWNER / PRESIDENT
Credential:
Phone: 240-646-4671