Provider Demographics
NPI:1922342914
Name:KBM HEALTH CARE AGENCY
Entity Type:Organization
Organization Name:KBM HEALTH CARE AGENCY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:
Authorized Official - First Name:BERNADETTE
Authorized Official - Middle Name:S
Authorized Official - Last Name:KAMARA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-200-5438
Mailing Address - Street 1:9400 BUENA VISTA AVE
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-6736
Mailing Address - Country:US
Mailing Address - Phone:301-200-5438
Mailing Address - Fax:186-670-7857
Practice Address - Street 1:9400 BUENA VISTA AVE
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-6736
Practice Address - Country:US
Practice Address - Phone:301-200-5438
Practice Address - Fax:186-670-7857
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-11-15
Last Update Date:2015-02-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No251C00000XAgenciesDay Training, Developmentally Disabled Services
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
No311Z00000XNursing & Custodial Care FacilitiesCustodial Care Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD9354000Medicaid
MD93540000Medicaid