Healthcare Provider Details

I. General information

NPI: 1538778063
Provider Name (Legal Business Name): BADMUS INSURANCE AGENCY
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/30/2020
Last Update Date: 08/13/2020
Certification Date: 08/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

46 SOLAR CIR APT A
PARKVILLE MD
21234-6831
US

IV. Provider business mailing address

46 SOLAR CIR APT A
PARKVILLE MD
21234-6831
US

V. Phone/Fax

Practice location:
  • Phone: 443-948-2126
  • Fax:
Mailing address:
  • Phone: 571-400-8461
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251X00000X
TaxonomySupports Brokerage Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code253J00000X
TaxonomyFoster Care 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. OLUWAPELUMI OLUKOTUN
Title or Position: EXECUTIVE PROGRAM DIRECTOR
Credential: BSN, MSHA, APRN, CCM
Phone: 571-400-8461