Provider Demographics
NPI:1043735988
Name:ACTIONCARE HEALTH HEALTH AND HUMAN SERVICES CORP
Entity type:Organization
Organization Name:ACTIONCARE HEALTH HEALTH AND HUMAN SERVICES CORP
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMNISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:NINNETTE
Authorized Official - Middle Name:
Authorized Official - Last Name:DOTSEY
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:703-725-0969
Mailing Address - Street 1:PO BOX 505
Mailing Address - Street 2:
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21041-0505
Mailing Address - Country:US
Mailing Address - Phone:703-725-0969
Mailing Address - Fax:410-480-3900
Practice Address - Street 1:8074 HIGH CASTLE RD
Practice Address - Street 2:
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21043-5516
Practice Address - Country:US
Practice Address - Phone:410-480-3200
Practice Address - Fax:410-480-3900
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ACTIONCARE HEALTH HEALTH AND HUMAN SERVICES CORP.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-08-12
Last Update Date:2017-08-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3924163W00000X, 163WC2100X, 163WW0000X, 164W00000X, 372600000X, 374U00000X, 376K00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes163W00000XNursing Service ProvidersRegistered NurseGroup - Multi-Specialty
No163WC2100XNursing Service ProvidersRegistered NurseContinence CareGroup - Multi-Specialty
No163WW0000XNursing Service ProvidersRegistered NurseWound CareGroup - Multi-Specialty
No164W00000XNursing Service ProvidersLicensed Practical NurseGroup - Multi-Specialty
No372600000XNursing Service Related ProvidersAdult CompanionGroup - Multi-Specialty
No374U00000XNursing Service Related ProvidersHome Health AideGroup - Multi-Specialty
No376K00000XNursing Service Related ProvidersNurse's AideGroup - Multi-Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MDR3924OtherDEPT. OF HEALTH AND MENTAL HYGIENE OFFICE OF HEALTH CARE QUALITY