Healthcare Provider Details

I. General information

NPI: 1215623855
Provider Name (Legal Business Name): AVID HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/17/2023
Last Update Date: 04/18/2023
Certification Date: 04/18/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

36 FALLS CHAPEL WAY
REISTERSTOWN MD
21136-3653
US

IV. Provider business mailing address

36 FALLS CHAPEL WAY
REISTERSTOWN MD
21136-3653
US

V. Phone/Fax

Practice location:
  • Phone: 410-830-0061
  • Fax:
Mailing address:
  • Phone: 410-830-0061
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: OLA OLUKANNI
Title or Position: ADMINISTRATOR
Credential:
Phone: 410-830-0061