=====================================================
General NPI Number Information
=====================================================
NPI Number | 1831515923
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | DMV HOME HEALTHCARE
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 03/12/2014
-----------------------------------------------------
Last Update Date | 03/12/2014
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 6475 NEW HAMPSHIRE AVE SUITE 504M
-----------------------------------------------------
City | HYATTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20783-3269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-501-9375
-----------------------------------------------------
Fax | 202-318-4337
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 6475 NEW HAMPSHIRE AVE SUITE 504M
-----------------------------------------------------
City | HYATTSVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20783-3269
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-501-9375
-----------------------------------------------------
Fax | 202-318-4337
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | ADMINISTRATOR
-----------------------------------------------------
Name | SCHOLASTIC GOUGH
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-501-9375
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 251E00000X
-----------------------------------------------------
Taxonomy Name | Home Health Agency
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State | MD
-----------------------------------------------------