Provider Demographics
NPI:1417489295
Name:SEPPK
Entity Type:Organization
Organization Name:SEPPK
Other - Org Name:CHEVI NATURAL HEALING
Other - Org Type:Doing Business As
Authorized Official - Title/Position:THERAPSIT
Authorized Official - Prefix:PROF
Authorized Official - First Name:DEUK
Authorized Official - Middle Name:B
Authorized Official - Last Name:KONG
Authorized Official - Suffix:
Authorized Official - Credentials:LMT
Authorized Official - Phone:410-875-7284
Mailing Address - Street 1:1224 W OLD LIBERTY RD
Mailing Address - Street 2:
Mailing Address - City:SYKESVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:21784-9327
Mailing Address - Country:US
Mailing Address - Phone:410-875-7284
Mailing Address - Fax:410-875-7284
Practice Address - Street 1:1224 W OLD LIBERTY RD
Practice Address - Street 2:
Practice Address - City:SYKESVILLE
Practice Address - State:MD
Practice Address - Zip Code:21784-9327
Practice Address - Country:US
Practice Address - Phone:410-875-7284
Practice Address - Fax:410-875-7284
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2017-03-30
Last Update Date:2017-03-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDM05267320700000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320700000XResidential Treatment FacilitiesResidential Treatment Facility, Physical Disabilities