Provider Demographics
NPI:1598258006
Name:OPENHEAVEN HEALTHCARE LLC
Entity Type:Organization
Organization Name:OPENHEAVEN HEALTHCARE LLC
Other - Org Name:OPENHEAVEN HEALTHCARE LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ADEDOKUN
Authorized Official - Middle Name:I
Authorized Official - Last Name:ADEKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-601-8037
Mailing Address - Street 1:11106 GLISSADE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1078
Mailing Address - Country:US
Mailing Address - Phone:240-253-2632
Mailing Address - Fax:240-345-5732
Practice Address - Street 1:11106 GLISSADE DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1078
Practice Address - Country:US
Practice Address - Phone:240-253-2632
Practice Address - Fax:240-345-5732
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-08
Last Update Date:2018-06-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR4091R251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR4091ROtherRESIDENTIAL SERVICE AGENCY LICENSE