Healthcare Provider Details

I. General information

NPI: 1043964885
Provider Name (Legal Business Name): FIRST HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/10/2022
Last Update Date: 04/08/2025
Certification Date: 04/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 SOUTHERN AVE
CAPITOL HEIGHTS MD
20743-5639
US

IV. Provider business mailing address

354 MONTECRISTO CT
SEVERN MD
21144-3440
US

V. Phone/Fax

Practice location:
  • Phone: 240-615-6881
  • Fax:
Mailing address:
  • Phone: 240-615-6881
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: DR. STANISLUS EBAI EBAN
Title or Position: CEO
Credential: PHD
Phone: 240-615-6881