Provider Demographics
NPI:1659158475
Name:BRENDA'S HEALTHCARE SERVICES
Entity Type:Organization
Organization Name:BRENDA'S HEALTHCARE SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:BEATRICE
Authorized Official - Middle Name:
Authorized Official - Last Name:FOMUNEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:405-361-8957
Mailing Address - Street 1:19 OBSERVATION CT APT 304
Mailing Address - Street 2:
Mailing Address - City:GERMANTOWN
Mailing Address - State:MD
Mailing Address - Zip Code:20876-6413
Mailing Address - Country:US
Mailing Address - Phone:405-361-8957
Mailing Address - Fax:
Practice Address - Street 1:3500 EAGLE RIDGE DR
Practice Address - Street 2:
Practice Address - City:WOODBRIDGE
Practice Address - State:VA
Practice Address - Zip Code:22191-6566
Practice Address - Country:US
Practice Address - Phone:405-361-8957
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-09-14
Last Update Date:2023-09-14
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities