Provider Demographics
NPI:1528207495
Name:LAVENPORT HOMECARE, LLC
Entity Type:Organization
Organization Name:LAVENPORT HOMECARE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:KOFI
Authorized Official - Middle Name:
Authorized Official - Last Name:AKOMEAH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-454-8174
Mailing Address - Street 1:14213 GRAND PRE RD
Mailing Address - Street 2:SUITE 201
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20906-2813
Mailing Address - Country:US
Mailing Address - Phone:301-300-9357
Mailing Address - Fax:
Practice Address - Street 1:14213 GRAND PRE RD
Practice Address - Street 2:SUITE 201
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20906-2813
Practice Address - Country:US
Practice Address - Phone:301-300-9357
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:LAVENPORT, LLC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2009-02-16
Last Update Date:2009-02-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2732P251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health