Healthcare Provider Details

I. General information

NPI: 1518493774
Provider Name (Legal Business Name): BEA'S HIVE ASSISTED LIVING
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/10/2017
Last Update Date: 05/10/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3014 NIGHTSIDE DRIVE
UPPER MARLBORO MD
20774
US

IV. Provider business mailing address

3014 NIGHTSIDE DRIVE
UPPER MARLBORO MD
20774
US

V. Phone/Fax

Practice location:
  • Phone: 240-565-7718
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberR203610
License Number StateMD

VIII. Authorized Official

Name: OLABIMPE OMOBOWALE OLOJO
Title or Position: CRNP
Credential:
Phone: 240-565-7718