Healthcare Provider Details

I. General information

NPI: 1124939475
Provider Name (Legal Business Name): ADONAI LEGACY COMMUNITY SUPPORTS, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/15/2026
Last Update Date: 09/15/2026
Certification Date: 09/15/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12619 CAMBLETON DR
UPPER MARLBORO MD
20774-1762
US

IV. Provider business mailing address

12619 CAMBLETON DR
UPPER MARLBORO MD
20774-1762
US

V. Phone/Fax

Practice location:
  • Phone: 202-733-0813
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number State

VIII. Authorized Official

Name: FABIOLA SAINT-SUME
Title or Position: RN
Credential: REGISTERED NURSE
Phone: 202-733-0813