Healthcare Provider Details

I. General information

NPI: 1336523729
Provider Name (Legal Business Name): COMMUNITY OF INFINITE POSSIBILITES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/15/2015
Last Update Date: 12/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8304 HARFORD RD 2ND FLOOR
PARKVILLE MD
21234-5700
US

IV. Provider business mailing address

8304 HARFORD RD 2ND FLOOR
PARKVILLE MD
21234-5700
US

V. Phone/Fax

Practice location:
  • Phone: 443-408-8045
  • Fax: 443-408-8050
Mailing address:
  • Phone: 443-408-8045
  • Fax: 443-408-8050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License NumberNS9912022
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: MS. AFREKA LYNCH
Title or Position: CO-OWNER
Credential:
Phone: 443-408-8045