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General NPI Number Information
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NPI Number | 1427697556
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Entity Type | Organization
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Legal Business Name | REDICARE MOBILE HEALTH SERVICE
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Dates
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Enumeration Date | 01/07/2020
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Last Update Date | 03/07/2023
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Provider Practice Location Address
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Address Line | 12410 MILESTONE CENTER DR STE 600
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City | GERMANTOWN
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State | MD
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Zip | 20876-7102
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Country | US
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Telephone | 240-743-8520
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Fax |
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Provider Business Mailing Address
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Address Line | 12410 MILESTONE CENTER DR STE 600
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City | GERMANTOWN
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State | MD
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Zip | 20876-7102
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Country | US
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Telephone | 301-307-5335
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Fax | 667-256-7022
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Authorized Official
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Title or Position | CEO/PHYSICIAN ASSISTANT
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Name | MRS. ASHLEY BROTHERS TOLLIVER
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Credential | PA-C
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Telephone | 240-743-8520
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 363L00000X
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Taxonomy Name | Nurse Practitioner
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 363A00000X
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Taxonomy Name | Physician Assistant
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License Number |
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License Number State |
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