Provider Demographics
NPI:1316705064
Name:FRESH FRESH HEALTHCARE AGENCY SECURITY SPO
Entity type:Organization
Organization Name:FRESH FRESH HEALTHCARE AGENCY SECURITY SPO
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:K
Authorized Official - Last Name:RODNEY
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:202-823-9346
Mailing Address - Street 1:7604 VICAR PL
Mailing Address - Street 2:
Mailing Address - City:NEW CARROLLTON
Mailing Address - State:MD
Mailing Address - Zip Code:20784-2966
Mailing Address - Country:US
Mailing Address - Phone:202-823-9346
Mailing Address - Fax:
Practice Address - Street 1:7604 VICAR PL
Practice Address - Street 2:
Practice Address - City:NEW CARROLLTON
Practice Address - State:MD
Practice Address - Zip Code:20784-2966
Practice Address - Country:US
Practice Address - Phone:202-823-9346
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FRESH FRESH HEALTH CARE AGENCY LLC,
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-03-07
Last Update Date:2024-03-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty