Provider Demographics
NPI:1922883222
Name:SAVICE, KORMASSAH BALLAH (COLLEGE STUDENT)
Entity Type:Individual
Prefix:MISS
First Name:KORMASSAH
Middle Name:BALLAH
Last Name:SAVICE
Suffix:
Gender:F
Credentials:COLLEGE STUDENT
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:11 HYACINTH CT
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20878-2840
Mailing Address - Country:US
Mailing Address - Phone:240-618-6837
Mailing Address - Fax:
Practice Address - Street 1:2412 FRANKLIN ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-4213
Practice Address - Country:US
Practice Address - Phone:202-848-9051
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2023-08-28
Last Update Date:2023-08-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD3747P1801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3747P1801XNursing Service Related ProvidersTechnicianPersonal Care Attendant