Provider Demographics
NPI:1699444034
Name:INTERIM HEALTHCARE OF PRINCE GEORGE'S COUNTY
Entity type:Organization
Organization Name:INTERIM HEALTHCARE OF PRINCE GEORGE'S COUNTY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER/DIRECTOR OF NURSING
Authorized Official - Prefix:
Authorized Official - First Name:KADY
Authorized Official - Middle Name:A
Authorized Official - Last Name:ADELEKE
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:240-509-9007
Mailing Address - Street 1:3032 MITCHELLVILLE RD STE 102
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1482
Mailing Address - Country:US
Mailing Address - Phone:240-510-1357
Mailing Address - Fax:
Practice Address - Street 1:3032 MITCHELLVILLE RD STE 102
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1482
Practice Address - Country:US
Practice Address - Phone:240-244-6424
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-09-09
Last Update Date:2022-11-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes251E00000XAgenciesHome Health
No163WH0200XNursing Service ProvidersRegistered NurseHome HealthGroup - Single Specialty
No251J00000XAgenciesNursing Care
No251X00000XAgenciesSupports Brokerage
No253Z00000XAgenciesIn Home Supportive Care