Healthcare Provider Details

I. General information

NPI: 1144561663
Provider Name (Legal Business Name): DEFYD SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/07/2013
Last Update Date: 03/07/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8902 MERRILL LN SUITE 302
LAUREL MD
20708-2024
US

IV. Provider business mailing address

8902 MERRILL LN SUITE 302
LAUREL MD
20708-2024
US

V. Phone/Fax

Practice location:
  • Phone: 410-262-1228
  • Fax:
Mailing address:
  • Phone: 410-262-1228
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR3371
License Number StateMD

VIII. Authorized Official

Name: MR. JOHN HARRISON FEDDY
Title or Position: ADMINISTRATOR
Credential:
Phone: 410-262-1228