Provider Demographics
NPI:1417364399
Name:STANDARD INTEGRATED SUPPORTS INC
Entity Type:Organization
Organization Name:STANDARD INTEGRATED SUPPORTS INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MUFU
Authorized Official - Middle Name:
Authorized Official - Last Name:ADEKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:718-812-2778
Mailing Address - Street 1:600 REISTERSTOWN RD
Mailing Address - Street 2:SUITE 300A
Mailing Address - City:PIKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21208-5104
Mailing Address - Country:US
Mailing Address - Phone:410-415-7025
Mailing Address - Fax:410-415-7026
Practice Address - Street 1:600 REISTERSTOWN RD
Practice Address - Street 2:SUITE 300A
Practice Address - City:PIKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21208-5104
Practice Address - Country:US
Practice Address - Phone:410-415-7025
Practice Address - Fax:410-415-7026
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-07-12
Last Update Date:2014-07-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3586251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care