Provider Demographics
NPI:1972946820
Name:ULTIMATE GOAL HOME CARE
Entity Type:Organization
Organization Name:ULTIMATE GOAL HOME CARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:ARREY
Authorized Official - Middle Name:K
Authorized Official - Last Name:ETCHIBANYI
Authorized Official - Suffix:
Authorized Official - Credentials:D
Authorized Official - Phone:301-982-6477
Mailing Address - Street 1:4920 NIAGARA RD STE 318-320
Mailing Address - Street 2:
Mailing Address - City:COLLEGE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20740-1110
Mailing Address - Country:US
Mailing Address - Phone:202-725-0560
Mailing Address - Fax:202-204-5726
Practice Address - Street 1:4920 NIAGARA RD STE 318-320
Practice Address - Street 2:
Practice Address - City:COLLEGE PARK
Practice Address - State:MD
Practice Address - Zip Code:20740-1110
Practice Address - Country:US
Practice Address - Phone:202-725-0560
Practice Address - Fax:202-204-5726
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-04-10
Last Update Date:2013-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDY510229115582251E00000X, 251J00000X, 302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
No302F00000XManaged Care OrganizationsExclusive Provider Organization