Provider Demographics
NPI:1891513081
Name:IDEAL LIVING HEALTHCARE SERVICES INC
Entity type:Organization
Organization Name:IDEAL LIVING HEALTHCARE SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:ISATU
Authorized Official - Middle Name:
Authorized Official - Last Name:SOW
Authorized Official - Suffix:
Authorized Official - Credentials:OWNER
Authorized Official - Phone:240-467-6895
Mailing Address - Street 1:5503 GREENPOINT LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4071
Mailing Address - Country:US
Mailing Address - Phone:240-467-6895
Mailing Address - Fax:
Practice Address - Street 1:5503 GREENPOINT LN
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20772-4071
Practice Address - Country:US
Practice Address - Phone:240-467-6895
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-27
Last Update Date:2024-10-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health