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General NPI Number Information
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NPI Number | 1609267269
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Entity Type | Organization
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Legal Business Name | SISTER MARYAM HOME, LLC
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Dates
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Enumeration Date | 02/18/2015
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Last Update Date | 02/18/2015
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Provider Practice Location Address
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Address Line | 4110 AMES ST NE 14
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City | WASHINGTON
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State | DC
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Zip | 20019-3309
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Country | US
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Telephone | 202-352-1510
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Fax |
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Provider Business Mailing Address
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Address Line | 13999 OLD COLUMBIA PIKE
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City | SILVER SPRING
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State | MD
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Zip | 20904-4557
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | FOUNDER
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Name | SALIMAH HIPPS
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Credential |
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Telephone | 202-352-1510
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State | MD
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