Provider Demographics
NPI:1477100147
Name:SHABACH MINISTRIES INC
Entity Type:Organization
Organization Name:SHABACH MINISTRIES INC
Other - Org Name:SHABACH HEALTH CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:HEALTH CENTER ADMINISTRATOR
Authorized Official - Prefix:DR
Authorized Official - First Name:GEORGINA
Authorized Official - Middle Name:AGYEKUM
Authorized Official - Last Name:MANZANO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-773-3600
Mailing Address - Street 1:3600 BRIGHTSEAT RD
Mailing Address - Street 2:
Mailing Address - City:LANDOVER
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2414
Mailing Address - Country:US
Mailing Address - Phone:301-773-3600
Mailing Address - Fax:
Practice Address - Street 1:403 BRIGHTSEAT RD
Practice Address - Street 2:
Practice Address - City:LANDOVER
Practice Address - State:MD
Practice Address - Zip Code:20785-4737
Practice Address - Country:US
Practice Address - Phone:301-773-3600
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:SHABACH MINISTRIES INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-08-19
Last Update Date:2020-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service