Healthcare Provider Details

I. General information

NPI: 1861920035
Provider Name (Legal Business Name): PURNA CARE SERVICES
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/31/2017
Last Update Date: 10/15/2021
Certification Date: 10/15/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9711 WASHINGTONIAN BLVD # 505
GAITHERSBURG MD
20878-7365
US

IV. Provider business mailing address

3540 CRAIN HWY STE 484
BOWIE MD
20716-1303
US

V. Phone/Fax

Practice location:
  • Phone: 240-390-6298
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State

VIII. Authorized Official

Name: DENEEN FRAZIER
Title or Position: OWNER
Credential:
Phone: 240-388-1642