1730887845 NPI number — EMINENCE HEALTHCARE SERVICES LLC

Table of content: IVANNA SAMANTHA ACOSTA MS (NPI 1790451268)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1730887845 NPI number — EMINENCE HEALTHCARE SERVICES LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
EMINENCE HEALTHCARE SERVICES 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:
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:
1730887845
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/17/2023
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
13000 BELLE MEADE TRCE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BOWIE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20720-4677
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-605-6112
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
13000 BELLE MEADE TRCE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20720-4677
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-605-6112
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
02/17/2023

Additional Information

Authorized Official

Authorized Official Last Name:
ONUH
Authorized Official First Name:
ROSETTA
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
240-605-6112

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 314000000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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