Healthcare Provider Details

I. General information

NPI: 1447978457
Provider Name (Legal Business Name): NEIGHBORHOOD NURSE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2022
Last Update Date: 10/26/2023
Certification Date: 10/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3421 GENTLE BREEZE DR STE A
UPPER MARLBORO MD
20772-2549
US

IV. Provider business mailing address

3421 GENTLE BREEZE DR
UPPR MARLBORO MD
20772-2549
US

V. Phone/Fax

Practice location:
  • Phone: 443-529-2027
  • Fax: 240-306-9503
Mailing address:
  • Phone: 144-352-9202
  • 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 Code253Z00000X
TaxonomyIn Home Supportive Care Agency
License Number
License Number State

VIII. Authorized Official

Name: TIMIKA SHANTE FISHER
Title or Position: MEDICAL DIRECTOR, CEO
Credential:
Phone: 443-529-2027