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General NPI Number Information
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NPI Number | 1427703511
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Entity Type | Organization
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Legal Business Name | IMARA HEALTH SERVICES LLC
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Dates
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Enumeration Date | 02/16/2022
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Last Update Date | 02/16/2022
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Provider Practice Location Address
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Address Line | 722 E MARKET ST STE 102
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City | LEESBURG
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State | VA
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Zip | 20176-4475
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Country | US
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Telephone | 240-422-6522
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Fax |
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Provider Business Mailing Address
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Address Line | 4505 VIRIDIAN TER
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City | MONROVIA
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State | MD
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Zip | 21770-6050
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Country | US
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Telephone | 240-422-6522
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | JACQUELINE ADOKO
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Credential |
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Telephone | 240-422-6522
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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