=====================================================
General NPI Number Information
=====================================================
NPI Number | 1396163051
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | AMICUS NURSING SERVICES INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/31/2014
-----------------------------------------------------
Last Update Date | 03/31/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 18412 CHARITY LN
-----------------------------------------------------
City | ACCOKEEK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20607-3246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-283-0676
-----------------------------------------------------
Fax | 301-283-0678
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 18412 CHARITY LN
-----------------------------------------------------
City | ACCOKEEK
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20607-3246
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-283-0676
-----------------------------------------------------
Fax | 301-283-0678
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | PRESIDENT
-----------------------------------------------------
Name | MRS. MERLYN VICRORIA SMITH
-----------------------------------------------------
Credential | RN
-----------------------------------------------------
Telephone | 301-283-0676
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number | HCO-14638
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number | R2505
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------