Organization
MEDICAID PERSONAL PROVIDERS, LLC
Active
Other names
Medicaid Personal Providers, LLC PT41
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
—
—
Other
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
R2091
—
MD
Enumeration date
05/21/2019
Last updated
05/21/2019
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