Healthcare Provider Details

I. General information

NPI: 1902380926
Provider Name (Legal Business Name): BAGIWA HEALTHCARE SERVICES LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/17/2018
Last Update Date: 05/05/2022
Certification Date: 05/05/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

15510 AITCHESON LN
LAUREL MD
20707-3044
US

IV. Provider business mailing address

10319 WESTLAKE DR # 115
BETHESDA MD
20817-6403
US

V. Phone/Fax

Practice location:
  • Phone: 240-603-6123
  • Fax: 19-050-4463
Mailing address:
  • Phone: 301-968-0961
  • Fax: 301-968-0961

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 Code251J00000X
TaxonomyNursing Care Agency
License Number
License Number State

VIII. Authorized Official

Name: ANN SMITH
Title or Position: OWNER/PRESIDENT
Credential: RN
Phone: 301-968-0961