NPIMap

Organization Active NPI

Phoenix Freedom Foundation of MD, Inc

  • Other Technician
  • Brandywine, MD
National Provider Identifier
1457002438
Registry record updated Jan 12, 2022
On this page

Key facts

NPPES NPI Registry
Primary specialty
Other TechnicianTaxonomy code 247200000X
Legal business name
PHOENIX FREEDOM FOUNDATION OF MD, INC
Practice address
14207 Kathleen LN
Brandywine, MD 20613-3006
Phone
(240) 443-1803
NPI assigned
Jan 12, 2022
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jan 12, 2022

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Dr. Quornelia A HypoliteNPI 1083365068
Title
Program Director/Ceo
Phone
(240) 443-1803

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Other TechnicianGroup: 193400000X SINGLE SPECIALTY GROUP 247200000X Primary
In Home Supportive Care Agency 253Z00000X
Child Intellectual and/or Developmental Disabilities Respite Care 385HR2060X

Addresses

Primary practice location

14207 Kathleen LN
Brandywine, MD 20613-3006

Mailing address

2957 Festival Way Ste 123
Waldorf, MD 20601-2959
Phone (240) 443-1803

National Provider Directory

National Provider Directory

Practitioners & affiliated clinicians

Practitioners 1

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1641945600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1641945600000",
    "number": "1457002438",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "2957 FESTIVAL WAY STE 123",
            "city": "WALDORF",
            "state": "MD",
            "postal_code": "206012959",
            "telephone_number": "240-443-1803"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "14207 KATHLEEN LN",
            "city": "BRANDYWINE",
            "state": "MD",
            "postal_code": "206133006",
            "telephone_number": "240-443-1803"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "PHOENIX FREEDOM FOUNDATION OF MD, INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2022-01-12",
        "last_updated": "2022-01-12",
        "certification_date": "2022-01-12",
        "status": "A",
        "authorized_official_last_name": "HYPOLITE",
        "authorized_official_first_name": "QUORNELIA",
        "authorized_official_middle_name": "A",
        "authorized_official_title_or_position": "PROGRAM DIRECTOR/CEO",
        "authorized_official_telephone_number": "240-443-1803",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "247200000X",
            "taxonomy_group": "193400000X SINGLE SPECIALTY  GROUP",
            "desc": "Technician, Other",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "253Z00000X",
            "taxonomy_group": "",
            "desc": "In Home Supportive Care",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "385HR2060X",
            "taxonomy_group": "",
            "desc": "Respite Care, Respite Care, Intellectual and/or Developmental Disabilities, Child",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Brandywine, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jan 12, 2022; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.