MEDICARE: IMPERIAL HEALTHCARE SERVICES 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	261QR0405X	Substance Use Disorder Rehabilitation Clinic/Center

General Provider Information

NPI Number	:	1699358390
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IMPERIAL HEALTHCARE SERVICES LLC

Provider Business Mailing Address
First Line	:	601 E NAYLOR MILL RD UNIT F
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21804-2256
Country	:	US
Telephone Number	:	410-572-4738
Fax Number	:	410-572-4649

Provider Business Practice Location Address
First Line	:	601 E NAYLOR MILL RD UNIT F
Second Line	:
City	:	SALISBURY
State	:	MD
Zip	:	21804-2256
Country	:	US
Telephone Number	:	410-572-4738
Fax Number	:	410-572-4649

Authorized Official
Title or Position	:	OWNER
Name	:	EMELDA NJEI
Credential	:	NP
Telephone Number	:	302-724-1181

Provider Enumeration Date	:	04/30/2021
Last Update Date	:	08/31/2021

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