Provider Demographics
NPI:1508598236
Name:SBOC HEALTHCARE
Entity Type:Organization
Organization Name:SBOC HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATION
Authorized Official - Prefix:
Authorized Official - First Name:MARIAMA
Authorized Official - Middle Name:
Authorized Official - Last Name:KOUGBAKA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-481-8983
Mailing Address - Street 1:7401 NEW HAMPSHIRE AVE APT 408
Mailing Address - Street 2:
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20912-6949
Mailing Address - Country:US
Mailing Address - Phone:240-481-8983
Mailing Address - Fax:
Practice Address - Street 1:7401 NEW HAMPSHIRE AVE APT 408
Practice Address - Street 2:
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20912-6949
Practice Address - Country:US
Practice Address - Phone:240-481-8983
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-30
Last Update Date:2022-06-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health