Provider Demographics
NPI:1902651086
Name:PROMINENT COMMUNITY HEALTH AND RESERCH LLC
Entity Type:Organization
Organization Name:PROMINENT COMMUNITY HEALTH AND RESERCH LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:BABATUNDE
Authorized Official - Middle Name:K
Authorized Official - Last Name:JIMOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-413-4131
Mailing Address - Street 1:6490 LANDOVER RD STE D3
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1443
Mailing Address - Country:US
Mailing Address - Phone:240-413-4131
Mailing Address - Fax:
Practice Address - Street 1:6490 LANDOVER RD STE D3
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1443
Practice Address - Country:US
Practice Address - Phone:240-413-4131
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-04-22
Last Update Date:2024-04-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health