Provider Demographics
NPI:1881063154
Name:SUPPLEMENTAL HEALTH
Entity type:Organization
Organization Name:SUPPLEMENTAL HEALTH
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OCCUPAITONAL THERAPIST
Authorized Official - Prefix:MS
Authorized Official - First Name:LINDA
Authorized Official - Middle Name:
Authorized Official - Last Name:PATE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-801-5816
Mailing Address - Street 1:9891 COLUMBIA LANE PKWY
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:DC
Mailing Address - Zip Code:21046
Mailing Address - Country:US
Mailing Address - Phone:301-362-0114
Mailing Address - Fax:866-566-5311
Practice Address - Street 1:1292 LIMIT AVE
Practice Address - Street 2:
Practice Address - City:IDLEWYLDE
Practice Address - State:MD
Practice Address - Zip Code:21239-1747
Practice Address - Country:US
Practice Address - Phone:443-801-5816
Practice Address - Fax:866-566-5311
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-09-17
Last Update Date:2015-09-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD05863314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility