=====================================================
General NPI Number Information
=====================================================
NPI Number | 1730678061
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | ISABELL HOME CARE ASSISTED LIVING LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 05/02/2018
-----------------------------------------------------
Last Update Date | 05/02/2018
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 11609 CANDOR DRIVE
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-929-6822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 11609 CANDOR DRIVE
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20721
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-929-6822
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ALM/MT
-----------------------------------------------------
Name | NOREEN ANGELA CROSLEY
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-583-9313
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 310400000X
-----------------------------------------------------
Taxonomy Name | Assisted Living Facility
-----------------------------------------------------
License Number | AL002223
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------