Healthcare Provider Details

I. General information

NPI: 1104273952
Provider Name (Legal Business Name): SETIF INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/23/2016
Last Update Date: 05/23/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4920 NIAGARA RD STE 107
COLLEGE PARK MD
20740-1121
US

IV. Provider business mailing address

908 LAKE SHORE DR
BOWIE MD
20721-2905
US

V. Phone/Fax

Practice location:
  • Phone: 301-446-3070
  • Fax: 301-446-3071
Mailing address:
  • Phone: 301-446-3070
  • Fax: 301-446-3071

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code305R00000X
TaxonomyPreferred Provider Organization
License Number
License Number State

VIII. Authorized Official

Name: OLUWAROTIMI WILLIAMS IKUSIKA
Title or Position: ADEMINISTRATOR
Credential:
Phone: 301-446-3070