=====================================================
General NPI Number Information
=====================================================
NPI Number | 1073784674
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | FLORENCE BOUA LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/21/2008
-----------------------------------------------------
Last Update Date | 03/21/2008
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6309 HOLLAND MEADOW LN
-----------------------------------------------------
City | LAYTONSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20882-1235
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-638-0811
-----------------------------------------------------
Fax | 800-332-6153
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11006 VEIRS MILL RD STE L15
-----------------------------------------------------
City | SILVER SPRING
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20902-5923
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-638-0811
-----------------------------------------------------
Fax | 800-332-6153
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | MRS. FLORENCE BOUA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 18003326153
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------