Provider Demographics
NPI:1710747316
Name:HEALTHY HIGHWAYS LLC
Entity Type:Organization
Organization Name:HEALTHY HIGHWAYS LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:BUSINESS OWNER
Authorized Official - Prefix:
Authorized Official - First Name:GLORIA
Authorized Official - Middle Name:
Authorized Official - Last Name:IZORE
Authorized Official - Suffix:
Authorized Official - Credentials:CRNP, FNP-C
Authorized Official - Phone:667-678-3872
Mailing Address - Street 1:10500 LITTLE PATUXENT PKWY # 1213
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21044-3585
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:19101 WILLOW GROVE RD
Practice Address - Street 2:
Practice Address - City:OLNEY
Practice Address - State:MD
Practice Address - Zip Code:20832-1232
Practice Address - Country:US
Practice Address - Phone:667-678-3872
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-20
Last Update Date:2024-03-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care