Provider Demographics
NPI:1255181160
Name:IMPECCABLE HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:IMPECCABLE HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF OPERATION
Authorized Official - Prefix:MRS
Authorized Official - First Name:RANTI
Authorized Official - Middle Name:OLUBUKOLA
Authorized Official - Last Name:OKE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-323-5124
Mailing Address - Street 1:13209 AILESBURY CT UPPR MARLBORO
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-6100
Mailing Address - Country:US
Mailing Address - Phone:301-323-5124
Mailing Address - Fax:
Practice Address - Street 1:9420 ANNAPOLIS RD STE 200
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3062
Practice Address - Country:US
Practice Address - Phone:301-323-5124
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-25
Last Update Date:2024-10-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No251S00000XAgenciesCommunity/Behavioral Health
No251V00000XAgenciesVoluntary or Charitable
No253Z00000XAgenciesIn Home Supportive Care
No261QR0401XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Comprehensive Outpatient Rehabilitation Facility (CORF)
No320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No385H00000XRespite Care FacilityRespite Care