Healthcare Provider Details

I. General information

NPI: 1235490327
Provider Name (Legal Business Name): CILLA'S ENTERPRISES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2012
Last Update Date: 06/05/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3008 PALADIN TER
OLNEY MD
20832-3005
US

IV. Provider business mailing address

3008 PALADIN TER
OLNEY MD
20832-3005
US

V. Phone/Fax

Practice location:
  • Phone: 301-728-8415
  • Fax: 240-342-2127
Mailing address:
  • Phone: 301-728-8415
  • Fax: 240-342-2127

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License NumberR3138
License Number StateMD

VIII. Authorized Official

Name: MS. PRISCILLA CHRISTIANA WALKER
Title or Position: ADMINISTRATOR
Credential:
Phone: 301-728-8415