Healthcare Provider Details

I. General information

NPI: 1942507843
Provider Name (Legal Business Name): FAWEMA NURSING CONTRACTOR, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/12/2011
Last Update Date: 04/25/2024
Certification Date: 04/25/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11460 CRONRIDGE DR STE 100
OWINGS MILLS MD
21117-2264
US

IV. Provider business mailing address

11460 CRONRIDGE DR STE 100
OWINGS MILLS MD
21117-2264
US

V. Phone/Fax

Practice location:
  • Phone: 301-220-0628
  • Fax: 301-220-0629
Mailing address:
  • Phone: 301-220-0628
  • Fax: 301-220-0629

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberR2947
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License NumberR2947
License Number StateMD

VIII. Authorized Official

Name: MRS. SUSAN NYAHALAY KONNEH
Title or Position: PRESIDENT/DIRECTOR OF NURSING
Credential: RN, CDDN
Phone: 301-220-0628