Provider Demographics
NPI:1417320441
Name:MEDSTATS HOMECARE SERVICES, LLC
Entity Type:Organization
Organization Name:MEDSTATS HOMECARE SERVICES, LLC
Other - Org Name:MEDSTATS HOMECARE SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:AYOBAMI
Authorized Official - Middle Name:
Authorized Official - Last Name:FASHINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-664-3977
Mailing Address - Street 1:10760 HICKORY RIDGE RD STE 123
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3682
Mailing Address - Country:US
Mailing Address - Phone:202-664-3977
Mailing Address - Fax:703-564-1449
Practice Address - Street 1:10760 HICKORY RIDGE RD STE 123
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3682
Practice Address - Country:US
Practice Address - Phone:443-492-9556
Practice Address - Fax:703-564-1449
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-11-13
Last Update Date:2015-11-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health