Provider Demographics
NPI:1902058423
Name:POTOMIC HOME HEALTH SERVICES INC.
Entity Type:Organization
Organization Name:POTOMIC HOME HEALTH SERVICES INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:RN
Authorized Official - Prefix:
Authorized Official - First Name:VIVIAN
Authorized Official - Middle Name:
Authorized Official - Last Name:MENTONGA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-462-2422
Mailing Address - Street 1:7205 PALMETTO SUNRISE CT
Mailing Address - Street 2:
Mailing Address - City:BRANDYWINE
Mailing Address - State:MD
Mailing Address - Zip Code:20613-8002
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:7205 PALMETTO SUNRISE CT
Practice Address - Street 2:
Practice Address - City:BRANDYWINE
Practice Address - State:MD
Practice Address - Zip Code:20613-8002
Practice Address - Country:US
Practice Address - Phone:240-462-2422
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-15
Last Update Date:2008-10-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health