Provider Demographics
NPI:1124212808
Name:PASSION HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:PASSION HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:HALIMAT
Authorized Official - Middle Name:EBUN
Authorized Official - Last Name:AKOJIE
Authorized Official - Suffix:
Authorized Official - Credentials:RN ,BSN, MHA
Authorized Official - Phone:301-856-4411
Mailing Address - Street 1:7707, PARNU CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-5327
Mailing Address - Country:US
Mailing Address - Phone:301-856-4411
Mailing Address - Fax:301-856-4422
Practice Address - Street 1:1300 MERCANTILE LN
Practice Address - Street 2:SUITE 138E
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5327
Practice Address - Country:US
Practice Address - Phone:301-856-4411
Practice Address - Fax:301-856-4422
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-09-05
Last Update Date:2016-04-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2403R251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD462006200Medicaid
MD229703500Medicaid