Healthcare Provider Details

I. General information

NPI: 1730974957
Provider Name (Legal Business Name): BRICKWOOD ASSISTED LIVING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2025
Last Update Date: 04/09/2025
Certification Date: 04/09/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5307 ELBURN LN
ROCK HALL MD
21661-2224
US

IV. Provider business mailing address

5307 ELBURN LN
ROCK HALL MD
21661-2224
US

V. Phone/Fax

Practice location:
  • Phone: 443-806-5766
  • Fax: 410-639-7236
Mailing address:
  • Phone: 443-806-5766
  • Fax: 410-639-7236

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code347C00000X
TaxonomyPrivate Vehicle
License Number
License Number State

VIII. Authorized Official

Name: ADEBOLA OJO
Title or Position: MANGER
Credential: MPH
Phone: 443-806-5766