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General NPI Number Information
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NPI Number | 1972809911
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Entity Type | Organization
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Legal Business Name | GOOD HEALTH NUTRITION SERVICES INC
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Dates
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Enumeration Date | 02/09/2011
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Last Update Date | 02/09/2011
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Provider Practice Location Address
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Address Line | 7515 ANNAPOLIS RD STE 402
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City | HYATTSVILLE
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State | MD
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Zip | 20784-1752
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Country | US
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Telephone | 301-577-1072
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Fax | 301-577-1073
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Provider Business Mailing Address
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Address Line | 7515 ANNAPOLIS RD STE 402
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City | HYATTSVILLE
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State | MD
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Zip | 20784-1752
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Country | US
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Telephone | 301-577-1072
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Fax | 301-577-1073
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. FLORENCE IFEOMA OMERENNAH
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Credential | D.O,
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Telephone | 301-577-1072
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 305R00000X
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Taxonomy Name | Preferred Provider Organization
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License Number | DX2507
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License Number State | MD
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Taxonomy #2
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Taxonomy Code | 305S00000X
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Taxonomy Name | Point of Service
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License Number | DX2507
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License Number State | MD
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Taxonomy #3
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Taxonomy Code | 302R00000X
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Taxonomy Name | Health Maintenance Organization
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License Number | DX 2507
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License Number State | MD
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