Provider Demographics
NPI:1942991609
Name:EXPRESS HOME & RENAL HEALTHCARE, LLC.
Entity Type:Organization
Organization Name:EXPRESS HOME & RENAL HEALTHCARE, LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:SOLOMON
Authorized Official - Middle Name:M
Authorized Official - Last Name:FON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-704-2667
Mailing Address - Street 1:10400 CONNECTICUT AVE STE 602
Mailing Address - Street 2:
Mailing Address - City:KENSINGTON
Mailing Address - State:MD
Mailing Address - Zip Code:20895-3909
Mailing Address - Country:US
Mailing Address - Phone:301-825-5900
Mailing Address - Fax:
Practice Address - Street 1:10400 CONNECTICUT AVE STE 602
Practice Address - Street 2:
Practice Address - City:KENSINGTON
Practice Address - State:MD
Practice Address - Zip Code:20895-3909
Practice Address - Country:US
Practice Address - Phone:301-825-5900
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-05-15
Last Update Date:2023-05-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)