MEDICARE: OBIMEM CARING HAND LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251J00000X	Nursing Care Agency	R3584R	MD

General Provider Information

NPI Number	:	1285042101
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OBIMEM CARING HAND LLC

Provider Business Mailing Address
First Line	:	1055 TAYLOR AVE STE 208
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21286-8333
Country	:	US
Telephone Number	:	410-419-3358
Fax Number	:	410-853-7604

Provider Business Practice Location Address
First Line	:	1055 TAYLOR AVE STE 208
Second Line	:
City	:	BALTIMORE
State	:	MD
Zip	:	21286-8333
Country	:	US
Telephone Number	:	410-419-3358
Fax Number	:	410-853-7604

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	MR. ANDREW EMEKA OBIEFULE SR.
Credential	:	LPN
Telephone Number	:	410-419-3358

Provider Enumeration Date	:	07/23/2014
Last Update Date	:	08/18/2016

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