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General NPI Number Information
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NPI Number | 1215649876
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Entity Type | Organization
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Legal Business Name | MIAH RESIDENTIAL AGENCY
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Dates
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Enumeration Date | 12/14/2022
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Last Update Date | 06/11/2023
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Provider Practice Location Address
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Address Line | 45 BLUE SPIRE CIR
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-1741
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Country | US
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Telephone | 443-629-5011
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Fax |
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Provider Business Mailing Address
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Address Line | 45 BLUE SPIRE CIR
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City | MIDDLE RIVER
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State | MD
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Zip | 21220-1741
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Country | US
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Telephone | 443-730-3894
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Fax |
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | OLANREWAJU DENNIS OJO
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Credential | RESIDENTAIL AGENT
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Telephone | 443-629-5011
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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License Number |
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License Number State |
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