Provider Demographics
NPI: | 1639980444 |
---|---|
Name: | ABABE HEALTH CARE CENTER LLC |
Entity type: | Organization |
Organization Name: | ABABE HEALTH CARE CENTER LLC |
Other - Org Name: | |
Other - Org Type: | |
Authorized Official - Title/Position: | CHIEF EXECUTIVE OFFICER |
Authorized Official - Prefix: | |
Authorized Official - First Name: | PETER |
Authorized Official - Middle Name: | FON |
Authorized Official - Last Name: | NDANG |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | NURSE PRACTITIONER |
Authorized Official - Phone: | 301-821-6222 |
Mailing Address - Street 1: | 9620 UTICA PL |
Mailing Address - Street 2: | |
Mailing Address - City: | SPRINGDALE |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20774-5450 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 301-821-6222 |
Mailing Address - Fax: | |
Practice Address - Street 1: | 9620 UTICA PL |
Practice Address - Street 2: | |
Practice Address - City: | SPRINGDALE |
Practice Address - State: | MD |
Practice Address - Zip Code: | 20774-5450 |
Practice Address - Country: | US |
Practice Address - Phone: | 301-821-6222 |
Practice Address - Fax: | |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2025-01-20 |
Last Update Date: | 2025-05-06 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization | Group |
---|---|---|---|---|---|
Yes | 363LP0808X | Physician Assistants & Advanced Practice Nursing Providers | Nurse Practitioner | Psychiatric/Mental Health | Group - Single Specialty |