MEDICARE: MEDICAID PERSONAL PROVIDERS, 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	251E00000X	Home Health Agency

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1588221048
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MEDICAID PERSONAL PROVIDERS, LLC

Provider Business Mailing Address
First Line	:	8555 16TH ST STE 105
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-2802
Country	:	US
Telephone Number	:	301-495-6330
Fax Number	:	301-495-6332

Provider Business Practice Location Address
First Line	:	8555 16TH ST STE 105
Second Line	:
City	:	SILVER SPRING
State	:	MD
Zip	:	20910-2802
Country	:	US
Telephone Number	:	301-495-6330
Fax Number	:	301-495-6332

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DAVID ELLWOOD GREENE
Credential	:
Telephone Number	:	301-495-6330

Provider Enumeration Date	:	05/21/2019
Last Update Date	:	05/21/2019

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