Provider Demographics
NPI:1235848052
Name:ULTIMA, LLC
Entity Type:Organization
Organization Name:ULTIMA, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:K.C.
Authorized Official - Middle Name:
Authorized Official - Last Name:GLEATON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-999-0999
Mailing Address - Street 1:2851 JESSUP RD UNIT 932
Mailing Address - Street 2:
Mailing Address - City:JESSUP
Mailing Address - State:MD
Mailing Address - Zip Code:20794-7545
Mailing Address - Country:US
Mailing Address - Phone:833-693-0833
Mailing Address - Fax:410-429-2968
Practice Address - Street 1:10320 LITTLE PATUXENT PKWY STE 200
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3344
Practice Address - Country:US
Practice Address - Phone:833-693-0833
Practice Address - Fax:410-429-2968
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-11-21
Last Update Date:2022-11-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332900000XSuppliersNon-Pharmacy Dispensing Site
No332B00000XSuppliersDurable Medical Equipment & Medical Supplies