Provider Demographics
NPI:1568904845
Name:PASSIONATE ASSISTED LIVING INC
Entity Type:Organization
Organization Name:PASSIONATE ASSISTED LIVING INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:OBEDIAH
Authorized Official - Middle Name:U
Authorized Official - Last Name:NWAGBARAOCHA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-790-2712
Mailing Address - Street 1:1248 CEDARCROFT RD
Mailing Address - Street 2:
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21239-1921
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1248 CEDARCROFT RD
Practice Address - Street 2:
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21239-1921
Practice Address - Country:US
Practice Address - Phone:410-790-2712
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-11-17
Last Update Date:2016-11-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD=========Medicaid