Provider Demographics
NPI:1467092866
Name:FOREMAN'S IMPERIAL HEALTH, LLC
Entity Type:Organization
Organization Name:FOREMAN'S IMPERIAL HEALTH, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OF ENTITY
Authorized Official - Prefix:
Authorized Official - First Name:CHRISTINA
Authorized Official - Middle Name:D
Authorized Official - Last Name:FOREMAN
Authorized Official - Suffix:
Authorized Official - Credentials:FNP
Authorized Official - Phone:301-326-9090
Mailing Address - Street 1:3910 SUSANNA RD
Mailing Address - Street 2:
Mailing Address - City:RANDALLSTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:21133-4056
Mailing Address - Country:US
Mailing Address - Phone:301-326-9090
Mailing Address - Fax:
Practice Address - Street 1:11710 REISTERSTOWN RD STE 207
Practice Address - Street 2:
Practice Address - City:REISTERSTOWN
Practice Address - State:MD
Practice Address - Zip Code:21136-3363
Practice Address - Country:US
Practice Address - Phone:301-326-9090
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-01-14
Last Update Date:2020-01-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Single Specialty