Healthcare Provider Details

I. General information

NPI: 1750021614
Provider Name (Legal Business Name): FRESH FRESH HEALTH CARE AGENCY LLC,
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/30/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7604 VICAR PL
NEW CARROLLTON MD
20784-2966
US

IV. Provider business mailing address

7604 VICAR PL
NEW CARROLLTON MD
20784-2966
US

V. Phone/Fax

Practice location:
  • Phone: 202-823-9346
  • Fax:
Mailing address:
  • Phone: 202-823-9346
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code103TA0700X
TaxonomyAdult Development & Aging Psychologist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code282J00000X
TaxonomyReligious Nonmedical Health Care Institution
License Number
License Number State

VIII. Authorized Official

Name: DR. ANDREA K RODNEY
Title or Position: CEO
Credential: PHD DR PHYSIOLOGY
Phone: 202-823-9346