Healthcare Provider Details

I. General information

NPI: 1487373270
Provider Name (Legal Business Name): WEST POINTE HEALTHCARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/24/2022
Last Update Date: 08/23/2023
Certification Date: 08/23/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3406 MEADOWDALE DR
WINDSOR MILL MD
21244-2236
US

IV. Provider business mailing address

3406 MEADOWDALE DR
WINDSOR MILL MD
21244-2236
US

V. Phone/Fax

Practice location:
  • Phone: 240-354-3205
  • Fax:
Mailing address:
  • Phone: 240-354-3205
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/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: CECELIA TAMBA
Title or Position: PRESIDENT
Credential:
Phone: 240-354-3205