=====================================================
General NPI Number Information
=====================================================
NPI Number | 1619114469
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | UNIVERSAL HEALTH SYSTEMS INC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 01/15/2009
-----------------------------------------------------
Last Update Date | 01/30/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 4 PROFESSIONAL DR SUITE 149
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20879-3407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-355-5272
-----------------------------------------------------
Fax | 301-355-5273
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 4 PROFESSIONAL DR SUITE 149
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20879-3407
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-355-5272
-----------------------------------------------------
Fax | 301-355-5273
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | NKEM D OLANREWAJU
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-355-5272
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | R2619
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------