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General NPI Number Information
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NPI Number | 1760783054
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Entity Type | Organization
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Legal Business Name | IDEAL HOMECARE, INC
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Dates
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Enumeration Date | 11/03/2010
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Last Update Date | 11/03/2010
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Provider Practice Location Address
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Address Line | 5617 AGER RD
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City | HYATTSVILLE
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State | MD
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Zip | 20782-3730
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Country | US
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Telephone | 301-559-6600
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Fax | 301-559-6700
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Provider Business Mailing Address
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Address Line | 5617 AGER RD
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City | HYATTSVILLE
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State | MD
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Zip | 20782-3730
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Country | US
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Telephone | 301-559-6600
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Fax | 301-559-6700
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Authorized Official
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Title or Position | ADMINSTRATOR
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Name | MRS. CAROL GRANT-GORDON
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Credential |
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Telephone | 301-559-6600
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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 | R2182
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License Number State | MD
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