1346655701 NPI number — BOAGEM HEALTHCARE SERVICES INC.

Table of content: (NPI 1346655701)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346655701 NPI number — BOAGEM HEALTHCARE SERVICES INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BOAGEM HEALTHCARE SERVICES 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:
6
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:
1346655701
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/24/2014
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4008 GENESEE PL
Provider Second Line Business Mailing Address:
SUITE 105
Provider Business Mailing Address City Name:
WOODBRIDGE
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22192-8306
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-580-8118
Provider Business Mailing Address Fax Number:
703-580-9308

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4008 GENESEE PL
Provider Second Line Business Practice Location Address:
SUITE 105
Provider Business Practice Location Address City Name:
WOODBRIDGE
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22192-8306
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
703-580-8118
Provider Business Practice Location Address Fax Number:
703-580-9308
Provider Enumeration Date:
06/24/2014

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BOATENG
Authorized Official First Name:
PRINCE
Authorized Official Middle Name:
AFARI
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
703-580-8118

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  HCO-14537 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 0156853951 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".
  • Identifier: 0156854413 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".