Abode Care Partners Al VB, LLC

Primary specialty

Nurse PractitionerTaxonomy code 363L00000X

Legal business name

ABODE CARE PARTNERS AL VB, LLC

Practice address

21412 Great Mills Rd
Lexington PK, MD 20653-1203

Phone

(301) 863-7244

Fax

(301) 863-8550

NPI assigned

Apr 6, 2010

Last updated

Dec 26, 2023By the provider in NPPES

Organization subpart

Yes

Parent organization

SHC MEDICAL PARTNERS, LLCAs reported in NPPES

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

Authorized official

Name

Angie Mattingly

Title

MGR Provider Enrollment

Phone

(502) 394-2100

Specialties & licenses 1

Addresses

Part of

SHC Medical Partners LLC

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

{
    "created_epoch": "1270512000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1703548800000",
    "number": "1770808446",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "12201 BLUEGRASS PKWY",
            "city": "LOUISVILLE",
            "state": "KY",
            "postal_code": "402992361",
            "telephone_number": "502-568-7896",
            "fax_number": "502-568-7136"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "21412 GREAT MILLS RD",
            "city": "LEXINGTON PK",
            "state": "MD",
            "postal_code": "206531203",
            "telephone_number": "301-863-7244",
            "fax_number": "301-863-8550"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "ABODE CARE PARTNERS AL VB, LLC",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "SHC MEDICAL PARTNERS, LLC",
        "enumeration_date": "2010-04-06",
        "last_updated": "2023-12-26",
        "certification_date": "2023-12-26",
        "status": "A",
        "authorized_official_last_name": "MATTINGLY",
        "authorized_official_first_name": "ANGIE",
        "authorized_official_title_or_position": "MGR PROVIDER ENROLLMENT",
        "authorized_official_telephone_number": "502-394-2100"
    },
    "taxonomies": [
        {
            "code": "363L00000X",
            "taxonomy_group": "",
            "desc": "Nurse Practitioner",
            "state": "NU",
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

• Nkiangu Alethia
• David Jack Cooper, DDS
• Todd Daniel Cooper, D.D.S.
• Elizabeth Ann Fryman, CRNP
• HQM of Bayside, LLC (Bayside Care Center at Lexington Park)

• Nurse Practitioner in Lexington PK, MD
• Providers in Lexington PK, MD by specialty
• Nurse Practitioner in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 26, 2023; 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.