Provider Demographics
NPI:1033667076
Name:DOMINION ACADEMY & HEALTHCARE SERVICES
Entity type:Organization
Organization Name:DOMINION ACADEMY & HEALTHCARE SERVICES
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:OWNER & DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:BLESSING
Authorized Official - Middle Name:JIM
Authorized Official - Last Name:MATTHEWS
Authorized Official - Suffix:
Authorized Official - Credentials:MBPA, BS, BSN RN
Authorized Official - Phone:202-409-6564
Mailing Address - Street 1:8855 ANNAPOLIS RD
Mailing Address - Street 2:SUITE 305
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2924
Mailing Address - Country:US
Mailing Address - Phone:240-770-7774
Mailing Address - Fax:240-770-3161
Practice Address - Street 1:8855 ANNAPOLIS RD
Practice Address - Street 2:SUITE 305
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2924
Practice Address - Country:US
Practice Address - Phone:240-770-7774
Practice Address - Fax:240-770-3161
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:DOMINION ACADEMY & HEALTHCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-09-20
Last Update Date:2016-12-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3923251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health