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General NPI Number Information
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NPI Number | 1598258006
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Entity Type | Organization
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Legal Business Name | OPENHEAVEN HEALTHCARE LLC
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Dates
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Enumeration Date | 06/08/2018
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Last Update Date | 06/08/2018
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Provider Practice Location Address
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Address Line | 11106 GLISSADE DR
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City | CLINTON
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State | MD
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Zip | 20735-1078
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Country | US
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Telephone | 240-253-2632
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Fax | 240-345-5732
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Provider Business Mailing Address
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Address Line | 11106 GLISSADE DR
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City | CLINTON
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State | MD
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Zip | 20735-1078
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Country | US
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Telephone | 240-253-2632
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Fax | 240-345-5732
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MR. ADEDOKUN I ADEKOYA
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Credential |
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Telephone | 240-601-8037
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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 | R4091R
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License Number State | MD
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