Organization · NPI-2

Advance Integrated Health, LLC

Clinic/Center, Multi-Specialty · Bowie, MD

NPI number1952934671
StatusActive
Last updated in NPPESFeb 20, 2020

Details

NPI
1952934671
Entity type
Organization (NPI-2)
Legal business name
Advance Integrated Health, LLC
Organization subpart
No
Enumeration date
Feb 20, 2020
Certification date
Feb 20, 2020
Last updated
Feb 20, 2020

Taxonomy and licenses

Taxonomy codeDescriptionLicenseStatePrimary
261QM1300X Clinic/Center, Multi-Specialty––Yes
251S00000X Community/Behavioral Health––
261QM0801X Clinic/Center, Mental Health (Including Community Mental Health Center)––
261QP2300X Clinic/Center, Primary Care––

Practice location

16204 Penterra Way
Bowie, MD 20716-1919

Phone 301-978-1990

Mailing address

16204 Penterra Way
Bowie, MD 20716-1919

Phone 301-978-1990

Authorized official

Deborah Kesewah Koroma
Nurse Practitioner
3019781990

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