1134525470 NPI number — WORLDSHINE INTERNATIONAL LLC

Table of content: KATHRYN D NEWELL M.D. (NPI 1003891011)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134525470 NPI number — WORLDSHINE INTERNATIONAL LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WORLDSHINE INTERNATIONAL LLC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
WORLDSHINE ADULT MEDICAL DAY CARE
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134525470
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
12/04/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
20420 CENTURY BLVD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
GERMANTOWN
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20874-1174
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-562-1999
Provider Business Mailing Address Fax Number:
301-540-0127

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
20420 CENTURY BLVD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
GERMANTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20874-1174
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-562-1999
Provider Business Practice Location Address Fax Number:
301-540-0127
Provider Enumeration Date:
11/14/2014

Additional Information

Authorized Official

Authorized Official Last Name:
LI
Authorized Official First Name:
QILI
Authorized Official Middle Name:
Authorized Official Title or Position:
MANAGING MEMBER
Authorized Official Telephone Number:
301-562-1999

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  15-004-A , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 15-004-A . This is a "DEPARTMENT OF HEALTH AND MENTAL HYGIENE OFFICE OF HEALTH CARE QUALITY" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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