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General NPI Number Information
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NPI Number | 1699105395
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Entity Type | Organization
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Legal Business Name | BALI HEALTHCARE, INC.
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Dates
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Enumeration Date | 11/15/2013
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Last Update Date | 11/19/2013
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Provider Practice Location Address
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Address Line | 1841 BRIGHTSEAT RD
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City | LANDOVER
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State | MD
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Zip | 20785-4250
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Country | US
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Telephone | 301-364-3300
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Fax | 301-364-3305
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Provider Business Mailing Address
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Address Line | PO BOX 6854
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City | LARGO
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State | MD
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Zip | 20792-6854
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Country | US
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Telephone | 301-364-3300
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Fax | 301-364-3305
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Authorized Official
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Title or Position | PRESIDENT/CEO
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Name | ALFRED SIBEDWO
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Credential |
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Telephone | 301-364-3300
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 2084P0800X
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Taxonomy Name | Psychiatry Physician
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License Number | D0052015
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 207Q00000X
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Taxonomy Name | Family Medicine Physician
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License Number | D0052015
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License Number State | MD
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