Healthcare Provider Details

I. General information

NPI: 1548050107
Provider Name (Legal Business Name): IZYHEALTHCARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2025
Last Update Date: 08/18/2026
Certification Date: 08/18/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

12774 WISTERIA DR # 353
GERMANTOWN MD
20874-9998
US

IV. Provider business mailing address

12774 WISTERIA DR # 353
GERMANTOWN MD
20874-9998
US

V. Phone/Fax

Practice location:
  • Phone: 240-813-0304
  • Fax: 641-206-7158
Mailing address:
  • Phone: 240-865-3144
  • Fax: 877-365-0899

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: IZEKU IZIEGBE EKATAH
Title or Position: CEO
Credential: CRNP-PMHNP
Phone: 240-865-3144