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General NPI Number Information
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NPI Number | 1669960779
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Entity Type | Organization
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Legal Business Name | MEDLINE HEALTH SERVICES
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Dates
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Enumeration Date | 04/24/2018
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Last Update Date | 04/24/2018
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Provider Practice Location Address
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Address Line | 11908 MAHER DR
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City | FORT WASHINGTON
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State | MD
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Zip | 20744
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Country | US
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Telephone | 301-235-3026
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Fax |
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Provider Business Mailing Address
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Address Line | 11908 MAHER DR
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City | FORT WASHINGTON
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State | MD
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Zip | 20744
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Country | US
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Telephone | 301-235-3026
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | ALFRED WILLIAM CANNON JR.
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Credential |
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Telephone | 301-235-3026
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251J00000X
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Taxonomy Name | Nursing Care Agency
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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 | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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Taxonomy #3
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Taxonomy Code | 261QR0208X
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Taxonomy Name | Mobile Radiology Clinic/Center
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License Number |
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License Number State |
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Taxonomy #4
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Taxonomy Code | 251E00000X
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Taxonomy Name | Home Health Agency
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License Number |
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License Number State |
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