Provider Demographics
NPI:1629361019
Name:CHEVY CHASE STAFFING AGENCY LLC
Entity Type:Organization
Organization Name:CHEVY CHASE STAFFING AGENCY LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MEMBER
Authorized Official - Prefix:MR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:JAMES
Authorized Official - Last Name:KIMBIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-944-2096
Mailing Address - Street 1:20306 THUNDERHEAD WAY
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20874-3806
Mailing Address - Country:US
Mailing Address - Phone:301-944-2096
Mailing Address - Fax:240-489-7883
Practice Address - Street 1:20306 THUNDERHEAD WAY
Practice Address - Street 2:
Practice Address - City:GERMANTOWN
Practice Address - State:MD
Practice Address - Zip Code:20874-3806
Practice Address - Country:US
Practice Address - Phone:301-944-2096
Practice Address - Fax:240-489-7883
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-05-18
Last Update Date:2011-05-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD101102251J00000X
MD110101251J00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251J00000XAgenciesNursing Care