Provider Demographics
NPI:1598030322
Name:ANDYSON HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:ANDYSON HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:PHILOMINA
Authorized Official - Middle Name:NGOZI
Authorized Official - Last Name:EGBE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-390-0729
Mailing Address - Street 1:15108 JENNINGS LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-7208
Mailing Address - Country:US
Mailing Address - Phone:301-390-0729
Mailing Address - Fax:301-390-0729
Practice Address - Street 1:15108 JENNINGS LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-7208
Practice Address - Country:US
Practice Address - Phone:301-390-0729
Practice Address - Fax:301-390-0729
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-03-12
Last Update Date:2012-03-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2361251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD153805500Medicaid