Provider Demographics
NPI:1568146900
Name:AMAZING PEARL LLC
Entity Type:Organization
Organization Name:AMAZING PEARL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:YETUNDE SHETEOLU
Authorized Official - Middle Name:
Authorized Official - Last Name:SHETEOLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-584-9454
Mailing Address - Street 1:1758 RICHFIELD DR
Mailing Address - Street 2:
Mailing Address - City:SEVERN
Mailing Address - State:MD
Mailing Address - Zip Code:21144-3025
Mailing Address - Country:US
Mailing Address - Phone:240-584-9454
Mailing Address - Fax:
Practice Address - Street 1:1758 RICHFIELD DR
Practice Address - Street 2:
Practice Address - City:SEVERN
Practice Address - State:MD
Practice Address - Zip Code:21144-3025
Practice Address - Country:US
Practice Address - Phone:240-584-9454
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-06-14
Last Update Date:2023-06-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
No251G00000XAgenciesHospice Care, Community Based
No385HR2065XRespite Care FacilityRespite CareRespite Care, Physical Disabilities, Child