Provider Demographics
NPI:1306678867
Name:JOMESA DE'LICE BOONE
Entity type:Organization
Organization Name:JOMESA DE'LICE BOONE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:JOMESA
Authorized Official - Middle Name:DE'LICE
Authorized Official - Last Name:BOONE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:410-689-5876
Mailing Address - Street 1:10411 HICKORY RIDGE RD APT B
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-4631
Mailing Address - Country:US
Mailing Address - Phone:410-689-5876
Mailing Address - Fax:
Practice Address - Street 1:10411 HICKORY RIDGE RD APT B
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21044-4631
Practice Address - Country:US
Practice Address - Phone:410-689-5876
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-08-14
Last Update Date:2024-08-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes374U00000XNursing Service Related ProvidersHome Health AideGroup - Single Specialty