=====================================================
General NPI Number Information
=====================================================
NPI Number | 1407456098
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | HANEI HEALTH SOLUTIONS, LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/31/2020
-----------------------------------------------------
Last Update Date | 10/31/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 9037 SHADY GROVE CT
-----------------------------------------------------
City | GAITHERSBURG
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20877-1301
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-741-2488
-----------------------------------------------------
Fax | 561-584-7338
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 451 N HUNGERFORD DR STE 119 RM 114
-----------------------------------------------------
City | ROCKVILLE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20850
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 443-741-2488
-----------------------------------------------------
Fax | 561-584-7338
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | OWNER
-----------------------------------------------------
Name | JUDDY MORGAN
-----------------------------------------------------
Credential | CRNP
-----------------------------------------------------
Telephone | 786-246-7326
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QM0801X
-----------------------------------------------------
Taxonomy Name | Mental Health Clinic/Center (Including Community Mental Health Center)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------