Provider Demographics
NPI:1528677747
Name:FRESH FRESH HEALTH CARE AGENCY LLC,
Entity type:Organization
Organization Name:FRESH FRESH HEALTH CARE AGENCY LLC,
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MISS
Authorized Official - First Name:ANDREA
Authorized Official - Middle Name:K
Authorized Official - Last Name:RODNEY
Authorized Official - Suffix:
Authorized Official - Credentials:DR
Authorized Official - Phone:202-696-7183
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:202-696-7183
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?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-23
Last Update Date:2025-06-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No103TM1800XBehavioral Health & Social Service ProvidersPsychologistIntellectual & Developmental DisabilitiesGroup - Multi-Specialty
No311500000XNursing & Custodial Care FacilitiesAlzheimer Center (Dementia Center)Group - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDP0000Medicaid
DC400321802319OtherDC BUSINESS LICENSES