Healthcare Provider Details

I. General information

NPI: 1053256560
Provider Name (Legal Business Name): HEPTAGON HEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/21/2026
Last Update Date: 04/21/2026
Certification Date: 04/21/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3803 KILBURN RD
RANDALLSTOWN MD
21133-4619
US

IV. Provider business mailing address

3505 FOXCLIFF CT APT 202
RANDALLSTOWN MD
21133-4926
US

V. Phone/Fax

Practice location:
  • Phone: 443-929-9775
  • Fax: 443-929-9775
Mailing address:
  • Phone: 443-929-9775
  • Fax: 443-929-9775

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WH0200X
TaxonomyHome Health Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: THERESA AMEH
Title or Position: MANAGING DIRECTOR/CEO
Credential: MD
Phone: 443-929-9775