Provider Demographics
NPI:1902380926
Name:BAGIWA HEALTHCARE SERVICES LLC
Entity Type:Organization
Organization Name:BAGIWA HEALTHCARE SERVICES LLC
Other - Org Name:BAGIWA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:OWNER/PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ANN
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-968-0961
Mailing Address - Street 1:10319 WESTLAKE DR # 115
Mailing Address - Street 2:
Mailing Address - City:BETHESDA
Mailing Address - State:MD
Mailing Address - Zip Code:20817-6403
Mailing Address - Country:US
Mailing Address - Phone:301-968-0961
Mailing Address - Fax:301-968-0961
Practice Address - Street 1:15510 AITCHESON LN
Practice Address - Street 2:
Practice Address - City:LAUREL
Practice Address - State:MD
Practice Address - Zip Code:20707-3044
Practice Address - Country:US
Practice Address - Phone:240-603-6123
Practice Address - Fax:019-050-4463
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-09-17
Last Update Date:2022-05-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251J00000XAgenciesNursing Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1902380926Medicaid