Provider Demographics
NPI:1831518802
Name:UKOH METRO MENTAL HEALTHCARE, PA
Entity type:Organization
Organization Name:UKOH METRO MENTAL HEALTHCARE, PA
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MRS
Authorized Official - First Name:IMMACULATA
Authorized Official - Middle Name:
Authorized Official - Last Name:UKOH
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE PRACTITIONER
Authorized Official - Phone:240-467-2116
Mailing Address - Street 1:4404 QUEENSBURY RD
Mailing Address - Street 2:
Mailing Address - City:RIVERDALE PARK
Mailing Address - State:MD
Mailing Address - Zip Code:20737-1068
Mailing Address - Country:US
Mailing Address - Phone:240-467-2116
Mailing Address - Fax:240-764-7527
Practice Address - Street 1:4404 QUEENSBURY RD
Practice Address - Street 2:
Practice Address - City:RIVERDALE PARK
Practice Address - State:MD
Practice Address - Zip Code:20737-1068
Practice Address - Country:US
Practice Address - Phone:240-467-2116
Practice Address - Fax:240-764-7527
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-04-07
Last Update Date:2014-04-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDAC 001241363LP0808X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
324369Medicare PIN