Provider Demographics
NPI:1710335732
Name:AAA PEDIATRIC N ADULT HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:AAA PEDIATRIC N ADULT HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLYN
Authorized Official - Middle Name:
Authorized Official - Last Name:BRYANT-TAYLOR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-605-5249
Mailing Address - Street 1:4518 BEECH RD
Mailing Address - Street 2:STE 315
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-6733
Mailing Address - Country:US
Mailing Address - Phone:301-464-6953
Mailing Address - Fax:
Practice Address - Street 1:4518 BEECH RD
Practice Address - Street 2:STE 315
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-6733
Practice Address - Country:US
Practice Address - Phone:301-464-6953
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-05-31
Last Update Date:2016-05-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health