Healthcare Provider Details

I. General information

NPI: 1336742048
Provider Name (Legal Business Name): MBI HEALTH SERVICES VIRGINIA LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/17/2020
Last Update Date: 11/17/2020
Certification Date: 11/17/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 WISCONSIN AVE STE 702
BETHESDA MD
20814-4891
US

IV. Provider business mailing address

7200 WISCONSIN AVE STE 702
BETHESDA MD
20814-4891
US

V. Phone/Fax

Practice location:
  • Phone: 202-215-5348
  • Fax:
Mailing address:
  • Phone: 202-215-5348
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: JOHN KAMYA
Title or Position: PRESIDENT
Credential:
Phone: 202-215-5348