Provider Demographics
NPI: | 1144820200 |
---|---|
Name: | SUUNA CHI HEALTHCARE SERVICES, LLC |
Entity type: | Organization |
Organization Name: | SUUNA CHI HEALTHCARE SERVICES, LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | OWNER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | FLORENCE |
Authorized Official - Middle Name: | A |
Authorized Official - Last Name: | NWANA |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | NP |
Authorized Official - Phone: | 443-803-5391 |
Mailing Address - Street 1: | 6609 REISTERSTOWN RD STE 201 |
Mailing Address - Street 2: | |
Mailing Address - City: | BALTIMORE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 21215-2634 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 301-604-4830 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 6609 REISTERSTOWN RD STE 201 |
Practice Address - Street 2: | |
Practice Address - City: | BALTIMORE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 21215-2634 |
Practice Address - Country: | US |
Practice Address - Phone: | 301-604-4830 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2020-10-28 |
Last Update Date: | 2020-10-28 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 2084B0040X | Allopathic & Osteopathic Physicians | Psychiatry & Neurology | Behavioral Neurology & Neuropsychiatry | Group - Multi-Specialty |