MEDICARE: KINDNESS MY SON'S LEGACY

Medicare Provider Information

Scope of Practice

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

#	Taxonomy Code	Taxonomy
1	163WR0006X	Registered Nurse First Assistant
2	253Z00000X	In Home Supportive Care Agency
3	261QH0100X	Health Service Clinic/Center
4	251J00000X	Nursing Care Agency

General Provider Information

NPI Number	:	1306674734
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	KINDNESS MY SON'S LEGACY

Provider Business Mailing Address
First Line	:	10326 VINCENT RD
Second Line	:
City	:	WHITE MARSH
State	:	MD
Zip	:	21162-1918
Country	:	US
Telephone Number	:	443-850-2500
Fax Number	:

Provider Business Practice Location Address
First Line	:	10326 VINCENT RD
Second Line	:
City	:	WHITE MARSH
State	:	MD
Zip	:	21162-1918
Country	:	US
Telephone Number	:	443-850-2500
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	NGOZI IBEWUIKE
Credential	:	MBA
Telephone Number	:	443-850-2500

Provider Enumeration Date	:	07/25/2024
Last Update Date	:	07/25/2024

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Directions to “KINDNESS MY SON'S LEGACY ” Practice Location

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