Provider Demographics
NPI:1235587817
Name:8759 CONTEE ROAD APT 404 LAUREL MD 20708
Entity Type:Organization
Organization Name:8759 CONTEE ROAD APT 404 LAUREL MD 20708
Other - Org Name:7009 WOODSTREAM TER LANHAM MD 20706
Other - Org Type:Other Name
Authorized Official - Title/Position:HHA
Authorized Official - Prefix:MISS
Authorized Official - First Name:MARIE
Authorized Official - Middle Name:
Authorized Official - Last Name:LUM
Authorized Official - Suffix:
Authorized Official - Credentials:HHA
Authorized Official - Phone:240-667-6347
Mailing Address - Street 1:8759 CONTEE RD APT 404
Mailing Address - Street 2:
Mailing Address - City:LAUREL
Mailing Address - State:MD
Mailing Address - Zip Code:20708-1927
Mailing Address - Country:US
Mailing Address - Phone:240-667-6347
Mailing Address - Fax:
Practice Address - Street 1:8759 CONTEE RD APT 404
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20708-1927
Practice Address - Country:US
Practice Address - Phone:240-667-6347
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-24
Last Update Date:2016-05-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHHA12114251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health