Provider Demographics
NPI:1164030102
Name:HIS FAITHFULNESS FAMILY CLINIC INC
Entity Type:Organization
Organization Name:HIS FAITHFULNESS FAMILY CLINIC INC
Other - Org Name:HIS FAITHFULNESS FAMILY CLINIC INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:OLIVIA
Authorized Official - Middle Name:
Authorized Official - Last Name:MBAH
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-257-2314
Mailing Address - Street 1:6188 OXON HILL RD STE 301
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20745-3157
Mailing Address - Country:US
Mailing Address - Phone:301-485-8151
Mailing Address - Fax:301-485-8191
Practice Address - Street 1:6188 OXON HILL RD STE 301
Practice Address - Street 2:
Practice Address - City:OXON HILL
Practice Address - State:MD
Practice Address - Zip Code:20745-3157
Practice Address - Country:US
Practice Address - Phone:301-485-8151
Practice Address - Fax:301-485-8191
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-15
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty
No261Q00000XAmbulatory Health Care FacilitiesClinic/Center