Provider Demographics
NPI:1598800211
Name:MOFRANKAL HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:MOFRANKAL HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:OHIREIME
Authorized Official - Middle Name:
Authorized Official - Last Name:BODUNRIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-945-7470
Mailing Address - Street 1:2300 GARRISON BLVD
Mailing Address - Street 2:#106
Mailing Address - City:BALTIMORE
Mailing Address - State:MD
Mailing Address - Zip Code:21216-2335
Mailing Address - Country:US
Mailing Address - Phone:410-945-7470
Mailing Address - Fax:443-283-4079
Practice Address - Street 1:2300 GARRISON BLVD
Practice Address - Street 2:#106
Practice Address - City:BALTIMORE
Practice Address - State:MD
Practice Address - Zip Code:21216-2335
Practice Address - Country:US
Practice Address - Phone:410-945-7470
Practice Address - Fax:410-945-7459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-20
Last Update Date:2009-06-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA05-278251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA010062934Medicaid
VA010062918Medicaid
VA010244749Medicaid
VA010062900Medicaid
VA010072875Medicaid