1497965727 NPI number — CARING HANDS OF FREDRICK, LLC

Table of content: (NPI 1497965727)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1497965727 NPI number — CARING HANDS OF FREDRICK, LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARING HANDS OF FREDRICK, LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1497965727
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/07/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4202 GREEN VALLEY RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
MONROVIA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21770-9517
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-865-4484
Provider Business Mailing Address Fax Number:
301-865-2844

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4202 GREEN VALLEY RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
MONROVIA
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21770-9517
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-865-4484
Provider Business Practice Location Address Fax Number:
301-865-2844
Provider Enumeration Date:
05/23/2007

Additional Information

Authorized Official

Authorized Official Last Name:
EATON
Authorized Official First Name:
PAMELA
Authorized Official Middle Name:
JEAN
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
301-865-4484

Provider Taxonomy Codes

  • Taxonomy code: 363LA2200X , with the licence number:  R050640 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: R050640 . This is a "NURSE PRACTITIONER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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