Provider Demographics
NPI:1407423650
Name:SSS3 ANGEL OF HOPE'S PEDIATRICS HOME & HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:SSS3 ANGEL OF HOPE'S PEDIATRICS HOME & HEALTHCARE SERVICES LLC
Other - Org Name:SWEET SERENITY SUCCESS SSS3 LLC
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:MARTINE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHERY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-813-5290
Mailing Address - Street 1:12389 GEORGIA AVE # 1051
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-3605
Mailing Address - Country:US
Mailing Address - Phone:443-813-5290
Mailing Address - Fax:
Practice Address - Street 1:5203 MIDWOOD AVE
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21212-4326
Practice Address - Country:US
Practice Address - Phone:443-813-5290
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-06-07
Last Update Date:2022-03-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208000000XAllopathic & Osteopathic PhysiciansPediatricsGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No253Z00000XAgenciesIn Home Supportive CareGroup - Multi-Specialty