Healthcare Provider Details

I. General information

NPI: 1639927999
Provider Name (Legal Business Name): GAVA HEALTHCARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2024
Last Update Date: 12/30/2024
Certification Date: 12/30/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

14502 GREENVIEW DR STE 500
LAUREL MD
20708-4245
US

IV. Provider business mailing address

14502 GREENVIEW DR STE 500
LAUREL MD
20708-4245
US

V. Phone/Fax

Practice location:
  • Phone: 240-202-2321
  • Fax:
Mailing address:
  • Phone: 240-202-2321
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code374U00000X
TaxonomyHome Health Aide
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code376J00000X
TaxonomyHomemaker
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: VALERIE UKPEH
Title or Position: ADMINISTRATOR
Credential:
Phone: 240-202-2321