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General NPI Number Information
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NPI Number | 1235587817
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Entity Type | Organization
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Legal Business Name | 8759 CONTEE ROAD APT 404 LAUREL MD 20708
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Dates
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Enumeration Date | 05/24/2016
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Last Update Date | 05/24/2016
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Provider Practice Location Address
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Address Line | 8759 CONTEE RD APT 404
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City | LAUREL
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State | MD
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Zip | 20708-1927
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Country | US
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Telephone | 240-667-6347
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Fax |
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Provider Business Mailing Address
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Address Line | 8759 CONTEE RD APT 404
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City | LAUREL
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State | MD
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Zip | 20708-1927
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Country | US
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Telephone | 240-667-6347
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Fax |
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Authorized Official
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Title or Position | HHA
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Name | MISS MARIE LUM
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Credential | HHA
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Telephone | 240-667-6347
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number | HHA12114
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License Number State | DC
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