Healthcare Provider Details

I. General information

NPI: 1447967591
Provider Name (Legal Business Name): CITADEL OF HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/28/2022
Last Update Date: 11/12/2022
Certification Date: 11/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

521 E JOPPA RD STE 205
TOWSON MD
21286-1802
US

IV. Provider business mailing address

521 E JOPPA RD STE 205
TOWSON MD
21286-1802
US

V. Phone/Fax

Practice location:
  • Phone: 443-374-2649
  • Fax:
Mailing address:
  • Phone: 443-653-9829
  • 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 Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State

VIII. Authorized Official

Name: MR. OLADAYO OLANIYAN
Title or Position: ADMINISTRATOR
Credential:
Phone: 443-303-7339