Provider Demographics
NPI:1316184138
Name:CONVENTIONAL HEALTH SERVICES, LLC
Entity Type:Organization
Organization Name:CONVENTIONAL HEALTH SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:TELFIE
Authorized Official - Middle Name:GEBEYEHU
Authorized Official - Last Name:LAKEW
Authorized Official - Suffix:
Authorized Official - Credentials:REGISTERED NURSE
Authorized Official - Phone:301-775-1861
Mailing Address - Street 1:11710 OLD GEORGETOWN RD APT 1109
Mailing Address - Street 2:1109
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20852-2681
Mailing Address - Country:US
Mailing Address - Phone:301-775-1861
Mailing Address - Fax:301-881-8328
Practice Address - Street 1:11710 OLD GEORGETOWN RD APT 1109
Practice Address - Street 2:1109
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20852-2681
Practice Address - Country:US
Practice Address - Phone:301-775-1861
Practice Address - Fax:301-881-8328
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2009-01-15
Last Update Date:2016-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR2671251E00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health