Provider Demographics
NPI:1053067876
Name:THE LILY VALLEY GROUP, INC.
Entity Type:Organization
Organization Name:THE LILY VALLEY GROUP, INC.
Other - Org Name:LILY HEALTH AND WELLNESS CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:DR
Authorized Official - First Name:SIMILADE
Authorized Official - Middle Name:
Authorized Official - Last Name:ADETUNJI
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, PMHNP,FNP
Authorized Official - Phone:240-401-5260
Mailing Address - Street 1:1600 BELLE DR
Mailing Address - Street 2:
Mailing Address - City:ANNAPOLIS
Mailing Address - State:MD
Mailing Address - Zip Code:21401-1147
Mailing Address - Country:US
Mailing Address - Phone:240-401-5260
Mailing Address - Fax:
Practice Address - Street 1:1600 BELLE DR
Practice Address - Street 2:
Practice Address - City:ANNAPOLIS
Practice Address - State:MD
Practice Address - Zip Code:21401-1147
Practice Address - Country:US
Practice Address - Phone:240-401-5260
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:THE LILY VALLEY GROUP, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2022-03-02
Last Update Date:2023-10-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty
No363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty