Healthcare Provider Details

I. General information

NPI: 1255945242
Provider Name (Legal Business Name): ADVANCED HEALTHCARE AND ALLIED SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/07/2020
Last Update Date: 09/08/2020
Certification Date: 09/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6305 IVY LN STE 101
GREENBELT MD
20770-6326
US

IV. Provider business mailing address

6305 IVY LN STE 101
GREENBELT MD
20770-6326
US

V. Phone/Fax

Practice location:
  • Phone: 301-765-4576
  • Fax:
Mailing address:
  • Phone: 301-765-4576
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251E00000X
TaxonomyHome Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: DR. GIDEON OBI
Title or Position: BUSINESS OWNER
Credential:
Phone: 301-765-4576