Provider Demographics
NPI:1730784398
Name:CHIVIC HEALTHCARE SERVICES LLC
Entity type:Organization
Organization Name:CHIVIC HEALTHCARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGING DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:NDIDIAMAKA
Authorized Official - Middle Name:EZINNE
Authorized Official - Last Name:MBAKPUO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-712-4637
Mailing Address - Street 1:7525 GREENWAY CENTER DR STE 316
Mailing Address - Street 2:
Mailing Address - City:GREENBELT
Mailing Address - State:MD
Mailing Address - Zip Code:20770-3525
Mailing Address - Country:US
Mailing Address - Phone:202-735-1010
Mailing Address - Fax:202-567-6361
Practice Address - Street 1:9470 ANNAPOLIS RD STE 416
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3000
Practice Address - Country:US
Practice Address - Phone:202-735-1010
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-02
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QU0200XAmbulatory Health Care FacilitiesClinic/CenterUrgent CareGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261Q00000XAmbulatory Health Care FacilitiesClinic/CenterGroup - Single Specialty
No261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty