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Organization

MEDICAID SERVICE, LLC

Active
Other names
Medicaid Personal Providers, Medicaid Personal Providers, LLC
Organization subpart
No

Provider details

NPI number
Authorized official
DAVID ELLWOOD GREENE (ADMINISTRATOR)
(301) 495-6330
Entity
Organization

Contact information

Practice address
8555 16TH ST STE 105, SILVER SPRING, MD 20910-2802
(301) 495-6330
(301) 495-6332
Mailing address
8555 16TH ST STE 105, SILVER SPRING, MD 20910-2802
(301) 495-6330
(301) 495-6332

Taxonomy

Speciality
Code
Description
License number
State
251E00000X
Home Health Agency
Primary
R2091
MD

Other

Other identifiers
Code
Description
Identifier
Issuer
State
05
474472100
MD
Enumeration date
11/03/2006
Last updated
07/20/2022
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