Healthcare Provider Details

I. General information

NPI: 1114093671
Provider Name (Legal Business Name): USA LANDSTUHL RMC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

LRMC CMR 402
APO AE
09180
DE

IV. Provider business mailing address

CMR 402 BOX 761
APO AE
09180
DE

V. Phone/Fax

Practice location:
  • Phone: 0114906371867276
  • Fax:
Mailing address:
  • Phone: 0114906371867276
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273R00000X
TaxonomyPsychiatric Hospital Unit
License NumberS-0021216
License Number StateOH

VIII. Authorized Official

Name: MS. JENNIFER MARIE AMICONE
Title or Position: SOCIAL WORKER
Credential: MSW, LSW
Phone: 0114906371867276