=====================================================
General NPI Number Information
=====================================================
NPI Number | 1861017519
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | CS HEALTHCARE SERVICES LLC
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 06/09/2020
-----------------------------------------------------
Last Update Date | 06/09/2020
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 1328 SOUTHERN AVE SE STE 205
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20032-4689
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-604-9571
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | PO BOX 2024
-----------------------------------------------------
City | BOWIE
-----------------------------------------------------
State | MD
-----------------------------------------------------
Zip | 20718-2024
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 240-230-7090
-----------------------------------------------------
Fax | 855-706-3131
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | BUSINESS MANAGER
-----------------------------------------------------
Name | CHARLETTA WASHINGTON
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 240-230-7090
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 363LF0000X
-----------------------------------------------------
Taxonomy Name | Family Nurse Practitioner
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------