Provider Demographics
NPI:1033816673
Name:NEBAMBETA HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:NEBAMBETA HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:GLADYS
Authorized Official - Middle Name:
Authorized Official - Last Name:NEBAFU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-904-0462
Mailing Address - Street 1:6100 GLENN DALE RD
Mailing Address - Street 2:
Mailing Address - City:GLENN DALE
Mailing Address - State:MD
Mailing Address - Zip Code:20769-9211
Mailing Address - Country:US
Mailing Address - Phone:202-904-0462
Mailing Address - Fax:
Practice Address - Street 1:6100 GLENN DALE RD
Practice Address - Street 2:
Practice Address - City:GLENN DALE
Practice Address - State:MD
Practice Address - Zip Code:20769-9211
Practice Address - Country:US
Practice Address - Phone:202-904-0462
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-02-14
Last Update Date:2023-02-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)