Provider Demographics
NPI:1164568978
Name:ASSURANCE HEALTHCARE SERVICES, LLC
Entity Type:Organization
Organization Name:ASSURANCE HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECITIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:LOIS
Authorized Official - Middle Name:E
Authorized Official - Last Name:BULLARD
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-422-2273
Mailing Address - Street 1:12301 OLD COLUMBIA PIKE STE 305
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20904-1730
Mailing Address - Country:US
Mailing Address - Phone:301-422-2273
Mailing Address - Fax:301-422-4104
Practice Address - Street 1:12301 OLD COLUMBIA PIKE STE 305
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20904-1730
Practice Address - Country:US
Practice Address - Phone:301-422-2273
Practice Address - Fax:301-422-4104
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ASSURANCE HEALTHCARE SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2007-01-29
Last Update Date:2023-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR1064251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD751713100Medicaid