Healthcare Provider Details

I. General information

NPI: 1790640316
Provider Name (Legal Business Name): BLUE OAK HEALTH SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2025
Last Update Date: 12/16/2025
Certification Date: 12/16/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1818 NEW YORK AVE NE STE 225
WASHINGTON DC
20002-1851
US

IV. Provider business mailing address

1818 NEW YORK AVE NE STE 225
WASHINGTON DC
20002-1851
US

V. Phone/Fax

Practice location:
  • Phone: 202-758-9347
  • Fax:
Mailing address:
  • Phone: 202-758-9347
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MR. NELSON BALINGWE
Title or Position: CEO
Credential:
Phone: 202-758-9347