1710497516 NPI number — EZIACESS NP HOUSECALLS LLC

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 1710497516 NPI number — EZIACESS NP HOUSECALLS LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EZIACESS NP HOUSECALLS 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:
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:
1710497516
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/22/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
14511 LAYHILL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
SILVER SPRING
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20906-1914
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2320 IVERSON ST STE 100
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TEMPLE HILLS
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20748-6801
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
848-256-0360
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
10/05/2017

Additional Information

Authorized Official

Authorized Official Last Name:
FORBIN
Authorized Official First Name:
LUCIA
Authorized Official Middle Name:
Authorized Official Title or Position:
NURSE PRACTITIONER
Authorized Official Telephone Number:
301-520-4135

Provider Taxonomy Codes

  • Taxonomy code: 207QA0505X , with the licence number:  R155157 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 363LF0000X , with the licence number: R155157 , 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: 14037773 . This is a "CAQH PROVIDER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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