Healthcare Provider Details

I. General information

NPI: 1215575634
Provider Name (Legal Business Name): CLS HEALTHSOLUTIONS, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/16/2019
Last Update Date: 10/29/2023
Certification Date: 10/29/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

137 NATIONAL PLZ STE 326
OXON HILL MD
20745-1152
US

IV. Provider business mailing address

137 NATIONAL PLZ STE 326
OXON HILL MD
20745-1152
US

V. Phone/Fax

Practice location:
  • Phone: 240-273-3130
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code207Q00000X
TaxonomyFamily Medicine Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code363L00000X
TaxonomyNurse Practitioner
License Number
License Number State

VIII. Authorized Official

Name: MS. KIM GLOVER
Title or Position: CREDENTIALING MANAGING / MEMBER
Credential:
Phone: 202-459-1568