1629302575 NPI number — GOOD HEALTH, HEALTH CARE AGENCY, INC.

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1629302575 NPI number — GOOD HEALTH, HEALTH CARE AGENCY, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GOOD HEALTH, HEALTH CARE AGENCY, INC.
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:
Provider Other Organization Name Type Code:
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:
1629302575
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/18/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
6480 NEW HAMPSHIRE AVE STE 305
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TAKOMA PARK
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20912-4716
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-270-4705
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
143 KENNEDY ST NW STE 3
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20011-5270
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-401-8764
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
09/24/2009

Additional Information

Authorized Official

Authorized Official Last Name:
OMERENNAH
Authorized Official First Name:
LAWRENCE
Authorized Official Middle Name:
CHUCK
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
240-401-8764

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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