=====================================================
General NPI Number Information
=====================================================
NPI Number | 1700212057
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | GREAT EXPECTATIONS
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 09/18/2013
-----------------------------------------------------
Last Update Date | 03/28/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6490 LANDOVER RD SUITE D ROOM #6
-----------------------------------------------------
City | CHEVERLY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20785-1443
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-200-8010
-----------------------------------------------------
Fax | 301-841-8016
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6490 LANDOVER RD SUITE D ROOM #6
-----------------------------------------------------
City | CHEVERLY
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20785
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 301-200-8010
-----------------------------------------------------
Fax | 301-841-8016
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | MR. ABRAHAM KOROMA
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 301-200-8010
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 163WC0400X
-----------------------------------------------------
Taxonomy Name | Case Management Registered Nurse
-----------------------------------------------------
License Number | HCO171179
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 163WC2100X
-----------------------------------------------------
Taxonomy Name | Continence Care Registered Nurse
-----------------------------------------------------
License Number | HCO171179
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #3
-----------------------------------------------------
Taxonomy Code | 163WH0200X
-----------------------------------------------------
Taxonomy Name | Home Health Registered Nurse
-----------------------------------------------------
License Number | HCO171179
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #4
-----------------------------------------------------
Taxonomy Code | 163WP0200X
-----------------------------------------------------
Taxonomy Name | Pediatric Registered Nurse
-----------------------------------------------------
License Number | HCO171179
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #5
-----------------------------------------------------
Taxonomy Code | 163WW0000X
-----------------------------------------------------
Taxonomy Name | Wound Care Registered Nurse
-----------------------------------------------------
License Number | HCO171179
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #6
-----------------------------------------------------
Taxonomy Code | 164W00000X
-----------------------------------------------------
Taxonomy Name | Licensed Practical Nurse
-----------------------------------------------------
License Number | HCO171179
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #7
-----------------------------------------------------
Taxonomy Code | 374U00000X
-----------------------------------------------------
Taxonomy Name | Home Health Aide
-----------------------------------------------------
License Number | HCO181179
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #8
-----------------------------------------------------
Taxonomy Code | 385H00000X
-----------------------------------------------------
Taxonomy Name | Respite Care
-----------------------------------------------------
License Number | 130702
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #9
-----------------------------------------------------
Taxonomy Code | 385HR2060X
-----------------------------------------------------
Taxonomy Name | Child Intellectual and/or Developmental Disabilities Respite Care
-----------------------------------------------------
License Number | 130702
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #10
-----------------------------------------------------
Taxonomy Code | 251B00000X
-----------------------------------------------------
Taxonomy Name | Case Management Agency
-----------------------------------------------------
License Number | 130702
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #11
-----------------------------------------------------
Taxonomy Code | 251F00000X
-----------------------------------------------------
Taxonomy Name | Home Infusion Agency
-----------------------------------------------------
License Number | 130702
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #12
-----------------------------------------------------
Taxonomy Code | 252Y00000X
-----------------------------------------------------
Taxonomy Name | Early Intervention Provider Agency
-----------------------------------------------------
License Number | HCO171179
-----------------------------------------------------
License Number State | VA
-----------------------------------------------------
Taxonomy #13
-----------------------------------------------------
Taxonomy Code | 253Z00000X
-----------------------------------------------------
Taxonomy Name | In Home Supportive Care Agency
-----------------------------------------------------
License Number | 130702
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #14
-----------------------------------------------------
Taxonomy Code | 320900000X
-----------------------------------------------------
Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
-----------------------------------------------------
License Number | 130702
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------
Taxonomy #15
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number | 130702
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------