Provider Demographics
NPI:1922615988
Name:DESIRE HEALTHCARE LLC
Entity Type:Organization
Organization Name:DESIRE HEALTHCARE LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:COURAGE
Authorized Official - Middle Name:NTUMLA
Authorized Official - Last Name:KWI-MANCHO
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:240-505-9321
Mailing Address - Street 1:9500 ANNAPOLIS RD STE B5
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-2078
Mailing Address - Country:US
Mailing Address - Phone:301-494-4060
Mailing Address - Fax:
Practice Address - Street 1:9500 ANNAPOLIS RD STE B5
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-2078
Practice Address - Country:US
Practice Address - Phone:301-494-4060
Practice Address - Fax:301-494-4055
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-09-24
Last Update Date:2021-11-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363L00000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerGroup - Multi-Specialty
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No363LP0808XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerPsychiatric/Mental HealthGroup - Multi-Specialty