Healthcare Provider Details

I. General information

NPI: 1982106928
Provider Name (Legal Business Name): JC HEALTH CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/06/2018
Last Update Date: 03/06/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8908 ELM AVE
BOWIE MD
20720-3612
US

IV. Provider business mailing address

8908 ELM AVE
BOWIE MD
20720-3612
US

V. Phone/Fax

Practice location:
  • Phone: 301-385-8517
  • Fax:
Mailing address:
  • Phone: 301-385-8517
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License NumberR172215
License Number StateMD

VIII. Authorized Official

Name: CHINMA NJOKU
Title or Position: OWNER
Credential: DNP
Phone: 301-464-1590