| NPI | 1063831519 |
|---|---|
| Former Legal Business Name | NONE |
| Entity Type | Organization |
| Authorized Contact | ELIZABETH NINI VEBANGSI Family Nurse Practitioner 301-792-0816 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QA0600X Clinic/Center, Adult Day Care |
| Additional Taxonomies | 251B00000X Case Management |
| 251C00000X | |
| 251E00000X Home Health | |
| 251F00000X Home Infusion | |
| 261QM0850X Clinic/Center, Adult Mental Health | |
| 261QM0855X Clinic/Center, Adolescent and Children Mental Health | |
| 293D00000X Physiological Laboratory | |
| 302R00000X Health Maintenance Organization (Licence: MD R150578) | |
| 305R00000X Preferred Provider Organization | |
| 313M00000X Nursing Facility/Intermediate Care Facility | |
| Enumeration Date | 2014-04-14 |
| Last Update Date | 2014-04-14 |