1730427147 NPI number — HEALTHCARE LIVING FOR FAMILIES

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730427147 NPI number — HEALTHCARE LIVING FOR FAMILIES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HEALTHCARE LIVING FOR FAMILIES
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:
1730427147
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/03/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3100 LORD BALTIMORE DRIVE
Provider Second Line Business Mailing Address:
SUITE 208
Provider Business Mailing Address City Name:
WINDSOR MILL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21244
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-701-7384
Provider Business Mailing Address Fax Number:
410-521-7005

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
3100 LORD BALTIMORE DRIVE
Provider Second Line Business Practice Location Address:
SUITE 208
Provider Business Practice Location Address City Name:
WINDSOR MILL
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21244
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-701-7384
Provider Business Practice Location Address Fax Number:
410-521-7005
Provider Enumeration Date:
01/18/2013

Additional Information

Authorized Official

Authorized Official Last Name:
OLASIMBO
Authorized Official First Name:
ADEMOLA
Authorized Official Middle Name:
Authorized Official Title or Position:
EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
410-701-7384

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X , with the licence number:  103663 , 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: 4204191 00 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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