Provider Demographics
NPI:1164828711
Name:SIMKY FAMILY & HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:SIMKY FAMILY & HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:NICKY
Authorized Official - Middle Name:NKECHI
Authorized Official - Last Name:ODAKA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:301-920-4230
Mailing Address - Street 1:407 DENNIS MAGRUDER DR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-2104
Mailing Address - Country:US
Mailing Address - Phone:301-283-8046
Mailing Address - Fax:
Practice Address - Street 1:407 DENNIS MAGRUDER DRIVE
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774
Practice Address - Country:US
Practice Address - Phone:301-283-8046
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SIMKY ENTERPRISES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-11-10
Last Update Date:2014-11-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD16873552251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD16873552Medicaid