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General NPI Number Information
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NPI Number | 1871088641
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Entity Type | Organization
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Legal Business Name | ACT HEALTH INTEGRATED SERVICES, LLC
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Dates
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Enumeration Date | 06/25/2018
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Last Update Date | 09/12/2023
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Provider Practice Location Address
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Address Line | 800 S FREDERICK AVE STE 208
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City | GAITHERSBURG
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State | MD
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Zip | 20877-4152
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Country | US
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Telephone | 301-679-5770
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Fax | 301-235-1520
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Provider Business Mailing Address
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Address Line | 800 S FREDERICK AVE STE 208
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City | GAITHERSBURG
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State | MD
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Zip | 20877-4152
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Country | US
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Telephone | 301-679-5770
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Fax | 301-235-1520
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Authorized Official
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Title or Position | FAMILY NURSE PRACTITIONER
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Name | DR. MARY FOWAAH BOATENG
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Credential | DNP
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Telephone | 301-679-5770
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM1300X
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Taxonomy Name | Multi-Specialty Clinic/Center
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License Number | R214992
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License Number State | MD
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