Provider Demographics
NPI:1972854826
Name:KADIE PRO HEALTH
Entity Type:Organization
Organization Name:KADIE PRO HEALTH
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MISS
Authorized Official - First Name:KADIATU
Authorized Official - Middle Name:HAWA
Authorized Official - Last Name:KANNEH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:240-938-4043
Mailing Address - Street 1:7701 AREHART DR
Mailing Address - Street 2:SUITE 1305
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-4163
Mailing Address - Country:US
Mailing Address - Phone:240-938-4043
Mailing Address - Fax:
Practice Address - Street 1:7701 AREHART DR
Practice Address - Street 2:SUITE 1305
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-4163
Practice Address - Country:US
Practice Address - Phone:240-938-4043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-01
Last Update Date:2012-10-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X251B00000X
251E00000X251E00000X
251J00000X251J00000X
253Z00000X253Z00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes253Z00000XAgenciesIn Home Supportive Care
No251B00000XAgenciesCase Management
No251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care