Healthcare Provider Details

I. General information

NPI: 1962124628
Provider Name (Legal Business Name): TERRA HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/19/2022
Last Update Date: 09/19/2022
Certification Date: 09/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

147 WESTWAY APT T2
GREENBELT MD
20770-1996
US

IV. Provider business mailing address

147 WESTWAY APT T2
GREENBELT MD
20770-1996
US

V. Phone/Fax

Practice location:
  • Phone: 240-487-8462
  • Fax:
Mailing address:
  • Phone: 240-487-8462
  • Fax:

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 Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. LILIAN LEANYUY
Title or Position: OWNER
Credential: PMHNP-BC
Phone: 240-487-8462