Healthcare Provider Details

I. General information

NPI: 1861763468
Provider Name (Legal Business Name): VTM HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2012
Last Update Date: 01/13/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

143 KENNEDY ST NW SUITE 10
WASHINGTON DC
20011-5228
US

IV. Provider business mailing address

143 KENNEDY ST NW SUITE 10
WASHINGTON DC
20011-5228
US

V. Phone/Fax

Practice location:
  • Phone: 202-450-3608
  • Fax:
Mailing address:
  • Phone: 202-450-3608
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WC0400X
TaxonomyCase Management Registered Nurse
License NumberRN1018823
License Number StateDC

VIII. Authorized Official

Name: NAOMI H MANDISHONA
Title or Position: RN/CASEMANAGER
Credential:
Phone: 202-450-3608