Provider Demographics
NPI:1356980270
Name:REHOBOTH MEDICAL CENTER LLC
Entity type:Organization
Organization Name:REHOBOTH MEDICAL CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:KATHRYN
Authorized Official - Middle Name:
Authorized Official - Last Name:MADUFORO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP, NP-C
Authorized Official - Phone:240-254-3375
Mailing Address - Street 1:11223 LOCKWOOD DR
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20901-4554
Mailing Address - Country:US
Mailing Address - Phone:240-254-3375
Mailing Address - Fax:410-844-6442
Practice Address - Street 1:11223 LOCKWOOD DR
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20901-4554
Practice Address - Country:US
Practice Address - Phone:240-254-3375
Practice Address - Fax:410-844-6442
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-23
Last Update Date:2024-06-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP2300XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPrimary CareGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty