Provider Demographics
NPI:1891573424
Name:REHOBOTH SUPPORT SERVICES LLC
Entity Type:Organization
Organization Name:REHOBOTH SUPPORT SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ATINUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:FADIPE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:240-278-1871
Mailing Address - Street 1:7007 SEQUOIA PL
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-1463
Mailing Address - Country:US
Mailing Address - Phone:202-740-9056
Mailing Address - Fax:
Practice Address - Street 1:7007 SEQUOIA PL
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-1463
Practice Address - Country:US
Practice Address - Phone:202-740-9056
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-15
Last Update Date:2023-09-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities