Provider Demographics
NPI:1609267269
Name:SISTER MARYAM HOME, LLC
Entity Type:Organization
Organization Name:SISTER MARYAM HOME, LLC
Other - Org Name:SISTER MARYAM HOME, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:SALIMAH
Authorized Official - Middle Name:
Authorized Official - Last Name:HIPPS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-352-1510
Mailing Address - Street 1:13999 OLD COLUMBIA PIKE
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-4557
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:4110 AMES ST NE
Practice Address - Street 2:14
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-3309
Practice Address - Country:US
Practice Address - Phone:202-352-1510
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-02-18
Last Update Date:2015-02-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD310400000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility