=====================================================
General NPI Number Information
=====================================================
NPI Number | 1811126485
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MASA HEALTHCARE, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 07/04/2009
-----------------------------------------------------
Last Update Date | 09/16/2009
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 10451 MILL RUN CIR STE 400
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-5594
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-356-8863
-----------------------------------------------------
Fax | 866-468-9901
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 10451 MILL RUN CIR STE 400
-----------------------------------------------------
City | OWINGS MILLS
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 21117-5594
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 410-356-8863
-----------------------------------------------------
Fax | 866-468-9901
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CEO
-----------------------------------------------------
Name | MR. MOHAMED ALI
-----------------------------------------------------
Credential | PTA
-----------------------------------------------------
Telephone | 443-204-2714
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------
Taxonomy #2
-----------------------------------------------------
Taxonomy Code | 261QP2000X
-----------------------------------------------------
Taxonomy Name | Physical Therapy Clinic/Center
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------