1861116758 NPI number — CARUTH STAFFING AGENCY P.C.

Table of content: KELLY ANN ARMENTROUT (NPI 1962030213)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1861116758 NPI number — CARUTH STAFFING AGENCY P.C.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CARUTH STAFFING AGENCY P.C.
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:
1861116758
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
10/03/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2114 GARDEN GROVE LN
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:
20721-1883
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
240-245-0039
Provider Business Mailing Address Fax Number:
301-542-0125

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2114 GARDEN GROVE LN
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:
20721-1883
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
240-245-0039
Provider Business Practice Location Address Fax Number:
301-542-0125
Provider Enumeration Date:
10/03/2022

Additional Information

Authorized Official

Authorized Official Last Name:
CARUTH
Authorized Official First Name:
MONIQUE
Authorized Official Middle Name:
JUNETTE
Authorized Official Title or Position:
OWNER/CEO
Authorized Official Telephone Number:
240-245-0039

Provider Taxonomy Codes

  • Taxonomy code: 101YM0800X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 241685 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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