Healthcare Provider Details

I. General information

NPI: 1891483905
Provider Name (Legal Business Name): XTRA MILES NURSING LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/26/2023
Last Update Date: 04/26/2023
Certification Date: 04/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3819 GAWAYNE TER
SILVER SPRING MD
20906-2656
US

IV. Provider business mailing address

3819 GAWAYNE TER
SILVER SPRING MD
20906-2656
US

V. Phone/Fax

Practice location:
  • Phone: 240-370-7509
  • Fax: 240-363-8106
Mailing address:
  • Phone: 240-370-7509
  • Fax: 240-363-8106

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 Code364SH0200X
TaxonomyHome Health Clinical Nurse Specialist
License Number
License Number State

VIII. Authorized Official

Name: MRS. OMOLARA ARIBISALA
Title or Position: OWNER/ PRESIDENT
Credential:
Phone: 240-370-7509