Provider Demographics
NPI:1770191660
Name:TREASURE HEALTH INC
Entity Type:Organization
Organization Name:TREASURE HEALTH INC
Other - Org Name:TREASURE HEALTH INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:RICHARD
Authorized Official - Middle Name:C
Authorized Official - Last Name:NGUNDAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-623-0782
Mailing Address - Street 1:6000 STEVENSON AVE STE F
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22304-3563
Mailing Address - Country:US
Mailing Address - Phone:703-461-4738
Mailing Address - Fax:703-461-3552
Practice Address - Street 1:6000 STEVENSON AVE STE F
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22304-3563
Practice Address - Country:US
Practice Address - Phone:703-461-4738
Practice Address - Fax:703-461-3552
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-07-17
Last Update Date:2023-01-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QD1600XAmbulatory Health Care FacilitiesClinic/CenterDevelopmental Disabilities
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA11079713OtherSCC