Provider Demographics
NPI:1023652781
Name:TLAY HEALTH CARE SERVICES,INC.
Entity type:Organization
Organization Name:TLAY HEALTH CARE SERVICES,INC.
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:TITILAYO
Authorized Official - Middle Name:MI
Authorized Official - Last Name:UNEGBU
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:240-521-3031
Mailing Address - Street 1:2021 CROSS CHURCH WAY
Mailing Address - Street 2:
Mailing Address - City:MITCHELLVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-2398
Mailing Address - Country:US
Mailing Address - Phone:301-322-1020
Mailing Address - Fax:301-322-4634
Practice Address - Street 1:2021 CROSS CHURCH WAY
Practice Address - Street 2:
Practice Address - City:MITCHELLVILLE
Practice Address - State:MD
Practice Address - Zip Code:20721-2398
Practice Address - Country:US
Practice Address - Phone:410-440-8763
Practice Address - Fax:301-322-4634
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TLAY HEALTH CARE SERVICES,INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-11-05
Last Update Date:2023-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR117409Medicaid
MDR117409OtherLICENSE