Provider Demographics
NPI:1558773366
Name:KADIE PRO HEALTH ASSISTED LIVING
Entity Type:Organization
Organization Name:KADIE PRO HEALTH ASSISTED LIVING
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:KADIATU
Authorized Official - Middle Name:HAWA
Authorized Official - Last Name:KANNEH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-938-4043
Mailing Address - Street 1:8301 DONOGHUE DR
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-3309
Mailing Address - Country:US
Mailing Address - Phone:301-552-3675
Mailing Address - Fax:301-577-1433
Practice Address - Street 1:8301 DONOGHUE DR
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-3309
Practice Address - Country:US
Practice Address - Phone:301-552-3675
Practice Address - Fax:301-577-1433
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-05-28
Last Update Date:2014-05-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3530385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care