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General NPI Number Information
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NPI Number | 1902669658
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Entity Type | Organization
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Legal Business Name | FORTUNE VENTURES 168 LLC
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Dates
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Enumeration Date | 02/05/2024
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Last Update Date | 02/05/2024
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Provider Practice Location Address
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Address Line | 10410 KENSINGTON PKWY STE 113
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City | KENSINGTON
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State | MD
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Zip | 20895-2950
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Country | US
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Telephone | 240-296-2330
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Fax |
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Provider Business Mailing Address
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Address Line | 10410 KENSINGTON PKWY STE 113
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City | KENSINGTON
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State | MD
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Zip | 20895-2950
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Country | US
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Telephone | 240-296-2330
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Fax |
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Authorized Official
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Title or Position | NURSING DIRECTOR
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Name | MARIA JOMALESA
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Credential |
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Telephone | 302-202-9880
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 253Z00000X
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Taxonomy Name | In Home Supportive Care Agency
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License Number |
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License Number State |
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