Healthcare Provider Details

I. General information

NPI: 1821855206
Provider Name (Legal Business Name): OUR SHEPHERD HEALTH CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/04/2024
Last Update Date: 08/05/2024
Certification Date: 08/05/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7525 GREENWAY CENTER DR STE 204
GREENBELT MD
20770-3525
US

IV. Provider business mailing address

7525 GREENWAY CENTER DR STE 204
GREENBELT MD
20770-3525
US

V. Phone/Fax

Practice location:
  • Phone: 240-542-4810
  • Fax: 240-254-3558
Mailing address:
  • Phone: 240-542-4810
  • Fax: 240-254-3558

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: JOAN OBOITE
Title or Position: OWNER
Credential: CRNP
Phone: 202-412-4224