Provider Demographics
NPI:1861254591
Name:DOC 2 PATIENT HEALTH SERVICES LLC
Entity type:Organization
Organization Name:DOC 2 PATIENT HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CRNP
Authorized Official - Prefix:
Authorized Official - First Name:SONGWE
Authorized Official - Middle Name:
Authorized Official - Last Name:KENKWA BASIL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:227-218-9388
Mailing Address - Street 1:15017 NORTHCOTE LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20716-1044
Mailing Address - Country:US
Mailing Address - Phone:227-218-9388
Mailing Address - Fax:
Practice Address - Street 1:15017 NORTHCOTE LN
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20716-1044
Practice Address - Country:US
Practice Address - Phone:227-218-9388
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-01-29
Last Update Date:2024-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service