Organization
PHOENIX FREEDOM FOUNDATION OF MD, INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DR. QUORNELIA A HYPOLITE (PROGRAM DIRECTOR/CEO)
(240) 443-1803
Entity
Organization
Contact information
Practice address
14207 KATHLEEN LN, BRANDYWINE, MD 20613-3006
(240) 443-1803
Mailing address
2957 FESTIVAL WAY STE 123, WALDORF, MD 20601-2959
(240) 443-1803
Taxonomy
Speciality
Code
Description
License number
State
247200000X
Other Technician
Primary
—
—
253Z00000X
In Home Supportive Care Agency
—
—
385HR2060X
Child Intellectual and/or Developmental Disabilities Respite Care
—
—
Other
Enumeration date
01/12/2022
Last updated
01/12/2022
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