Healthcare Provider Details

I. General information

NPI: 1811649015
Provider Name (Legal Business Name): PATIENT CENTERED HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/19/2022
Last Update Date: 01/19/2022
Certification Date: 01/18/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6210 FOSTER ST
DISTRICT HEIGHTS MD
20747-1206
US

IV. Provider business mailing address

6210 FOSTER ST
DISTRICT HEIGHTS MD
20747-1206
US

V. Phone/Fax

Practice location:
  • Phone: 240-770-6689
  • Fax: 855-451-0224
Mailing address:
  • Phone: 240-770-6689
  • Fax: 855-451-0224

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QU0200X
TaxonomyUrgent Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CAROLINE AINA IBIJEMILUSI
Title or Position: PROVIDER
Credential:
Phone: 240-770-6689