Healthcare Provider Details

I. General information

NPI: 1790559151
Provider Name (Legal Business Name): ADORN MEDICAL CARE SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/07/2023
Last Update Date: 11/28/2023
Certification Date: 11/28/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4514 BENNING RD SE
WASHINGTON DC
20019-5149
US

IV. Provider business mailing address

11801 BISHOPS CONTENT RD
BOWIE MD
20721-2570
US

V. Phone/Fax

Practice location:
  • Phone: 202-800-6500
  • Fax:
Mailing address:
  • Phone: 240-413-4881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: ELIZABETH NINI VEBANGSI
Title or Position: OWNER
Credential: NP
Phone: 240-486-2783