Healthcare Provider Details

I. General information

NPI: 1326934696
Provider Name (Legal Business Name): UP & HALE LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/14/2025
Last Update Date: 06/14/2025
Certification Date: 06/14/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

13992 BALTIMORE AVE STE 202
LAUREL MD
20707-5010
US

IV. Provider business mailing address

13992 BALTIMORE AVE STE 202
LAUREL MD
20707-5010
US

V. Phone/Fax

Practice location:
  • Phone: 240-486-2087
  • Fax:
Mailing address:
  • Phone: 240-486-2087
  • 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
# 3
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: TITILAYO B SHAKIRU
Title or Position: PROGRAM ADMINISTRATOR
Credential:
Phone: 240-486-2087