Healthcare Provider Details

I. General information

NPI: 1861254591
Provider Name (Legal Business Name): DOC 2 PATIENT HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2024
Last Update Date: 01/29/2024
Certification Date: 01/28/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15017 NORTHCOTE LN
BOWIE MD
20716-1044
US

IV. Provider business mailing address

15017 NORTHCOTE LN
BOWIE MD
20716-1044
US

V. Phone/Fax

Practice location:
  • Phone: 227-218-9388
  • Fax:
Mailing address:
  • Phone: 227-218-9388
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SONGWE KENKWA BASIL
Title or Position: CRNP
Credential:
Phone: 227-218-9388