Provider Demographics
NPI:1679918452
Name:MEDSTATS RESIDENTIAL AGENCY
Entity Type:Organization
Organization Name:MEDSTATS RESIDENTIAL AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO/OWNER
Authorized Official - Prefix:
Authorized Official - First Name:AYOBAMI
Authorized Official - Middle Name:O
Authorized Official - Last Name:FASHINA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-664-3977
Mailing Address - Street 1:10760 HICKORY RIDGE RD STE 123
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3682
Mailing Address - Country:US
Mailing Address - Phone:202-664-3977
Mailing Address - Fax:443-542-9372
Practice Address - Street 1:10760 HICKORY RIDGE RD STE 123
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-3682
Practice Address - Country:US
Practice Address - Phone:202-664-3977
Practice Address - Fax:443-542-9372
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-05-07
Last Update Date:2014-02-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health