Healthcare Provider Details

I. General information

NPI: 1609717883
Provider Name (Legal Business Name): FIRST HEALTH SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/02/2026
Last Update Date: 04/02/2026
Certification Date: 04/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4411 SOUTHERN AVE
CAPITOL HEIGHTS MD
20743-5639
US

IV. Provider business mailing address

4411 SOUTHERN AVE
CAPITOL HEIGHTS MD
20743-5639
US

V. Phone/Fax

Practice location:
  • Phone: 240-633-6156
  • Fax: 240-633-6156
Mailing address:
  • Phone: 240-633-6156
  • Fax: 240-633-6156

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0804X
TaxonomyChild & Adolescent Psychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code104100000X
TaxonomySocial Worker
License Number
License Number State

VIII. Authorized Official

Name: STANISLUS EBAN
Title or Position: CEO
Credential: PHD
Phone: 240-633-6156