Provider Demographics
NPI:1912773839
Name:OPENHEAVEN HEALTHCARE LLC
Entity Type:Organization
Organization Name:OPENHEAVEN HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:ADEDOKUN
Authorized Official - Middle Name:IDOWU
Authorized Official - Last Name:ADEKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:ADMINISTRATION
Authorized Official - Phone:240-601-8037
Mailing Address - Street 1:11106 GLISSADE DR
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-1078
Mailing Address - Country:US
Mailing Address - Phone:240-601-8037
Mailing Address - Fax:240-253-2632
Practice Address - Street 1:11106 GLISSADE DR
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-1078
Practice Address - Country:US
Practice Address - Phone:240-601-8037
Practice Address - Fax:240-253-2632
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-12-01
Last Update Date:2023-12-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health