Provider Demographics
NPI:1215649876
Name:MIAH RESIDENTIAL AGENCY
Entity type:Organization
Organization Name:MIAH RESIDENTIAL AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:OLANREWAJU
Authorized Official - Middle Name:DENNIS
Authorized Official - Last Name:OJO
Authorized Official - Suffix:
Authorized Official - Credentials:RESIDENTAIL AGENT
Authorized Official - Phone:443-629-5011
Mailing Address - Street 1:45 BLUE SPIRE CIR
Mailing Address - Street 2:
Mailing Address - City:MIDDLE RIVER
Mailing Address - State:MD
Mailing Address - Zip Code:21220-1741
Mailing Address - Country:US
Mailing Address - Phone:443-730-3894
Mailing Address - Fax:
Practice Address - Street 1:45 BLUE SPIRE CIR
Practice Address - Street 2:
Practice Address - City:MIDDLE RIVER
Practice Address - State:MD
Practice Address - Zip Code:21220-1741
Practice Address - Country:US
Practice Address - Phone:443-629-5011
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-12-14
Last Update Date:2023-06-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care