Provider Demographics
NPI:1891550786
Name:MAXGIO HEALTHCARE LLC
Entity Type:Organization
Organization Name:MAXGIO HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PMHNP
Authorized Official - Prefix:
Authorized Official - First Name:ROSE
Authorized Official - Middle Name:
Authorized Official - Last Name:CHIGBO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:701-729-2970
Mailing Address - Street 1:411 BRANCHWAY RD STE 109
Mailing Address - Street 2:
Mailing Address - City:NORTH CHESTERFIELD
Mailing Address - State:VA
Mailing Address - Zip Code:23236-3034
Mailing Address - Country:US
Mailing Address - Phone:804-901-0053
Mailing Address - Fax:804-509-0514
Practice Address - Street 1:411 BRANCHWAY RD STE 109
Practice Address - Street 2:
Practice Address - City:NORTH CHESTERFIELD
Practice Address - State:VA
Practice Address - Zip Code:23236-3034
Practice Address - Country:US
Practice Address - Phone:804-901-0053
Practice Address - Fax:804-509-0514
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-02-19
Last Update Date:2024-02-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Single Specialty