Provider Demographics
NPI:1093034894
Name:EXPANDING POTENTIALS LLC
Entity Type:Organization
Organization Name:EXPANDING POTENTIALS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MISS
Authorized Official - First Name:BRANDY
Authorized Official - Middle Name:KUEREINE
Authorized Official - Last Name:O'ROURKE
Authorized Official - Suffix:
Authorized Official - Credentials:MED, BCBA, LBA
Authorized Official - Phone:301-801-1376
Mailing Address - Street 1:PO BOX 7053
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21045-7053
Mailing Address - Country:US
Mailing Address - Phone:301-801-1376
Mailing Address - Fax:443-817-0715
Practice Address - Street 1:5895 MORNINGBIRD LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21045-3520
Practice Address - Country:US
Practice Address - Phone:301-801-1376
Practice Address - Fax:443-817-0715
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-05-19
Last Update Date:2023-04-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA1-07-3491251C00000X
251E00000X, 251S00000X, 253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No251S00000XAgenciesCommunity/Behavioral Health
No253Z00000XAgenciesIn Home Supportive Care