Provider Demographics
NPI:1053718544
Name:MUSTARDSEED HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:MUSTARDSEED HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CLINICAL DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTA
Authorized Official - Middle Name:
Authorized Official - Last Name:NDIFOR
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:240-439-4373
Mailing Address - Street 1:198 THOMAS JOHNSON DR
Mailing Address - Street 2:STE 205
Mailing Address - City:FREDERICK
Mailing Address - State:MD
Mailing Address - Zip Code:21702-4398
Mailing Address - Country:US
Mailing Address - Phone:240-439-4373
Mailing Address - Fax:240-439-4396
Practice Address - Street 1:198 THOMAS JOHNSON DR
Practice Address - Street 2:STE 205
Practice Address - City:FREDERICK
Practice Address - State:MD
Practice Address - Zip Code:21702-4398
Practice Address - Country:US
Practice Address - Phone:240-439-4373
Practice Address - Fax:240-439-4396
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-26
Last Update Date:2014-11-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR3304251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD628404300Medicaid