Healthcare Provider Details

I. General information

NPI: 1639554363
Provider Name (Legal Business Name): IMELDA ANYAOHA
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/23/2015
Last Update Date: 07/23/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3208 HUNTING HORN LN
UPPER MARLBORO MD
20774-7548
US

IV. Provider business mailing address

3208 HUNTING HORN LN
SPRINGDALE MD
20774-7548
US

V. Phone/Fax

Practice location:
  • Phone: 301-773-4561
  • Fax:
Mailing address:
  • Phone: 301-773-4561
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code3140N1450X
TaxonomyPediatric Skilled Nursing Facility
License NumberLP34473
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License NumberLP34473
License Number StateMD

VIII. Authorized Official

Name: IMELDA CHIGOZIE ANYAOHA II
Title or Position: LPN
Credential:
Phone: 301-773-4561