Provider Demographics
NPI:1972859866
Name:TA HEALTH SERVICES
Entity Type:Organization
Organization Name:TA HEALTH SERVICES
Other - Org Name:TA HEALTH SERVICES
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CO FOUNDER
Authorized Official - Prefix:
Authorized Official - First Name:JEANNE
Authorized Official - Middle Name:
Authorized Official - Last Name:UTEMESI
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:202-704-7218
Mailing Address - Street 1:8839 STONEBROOK LN
Mailing Address - Street 2:
Mailing Address - City:COLUMBIA
Mailing Address - State:MD
Mailing Address - Zip Code:21046-1415
Mailing Address - Country:US
Mailing Address - Phone:202-704-7218
Mailing Address - Fax:
Practice Address - Street 1:8839 STONEBROOK LN
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1415
Practice Address - Country:US
Practice Address - Phone:202-704-7218
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:TAHEALTHSERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2012-07-28
Last Update Date:2012-07-28
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNSA-0230302F00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes302F00000XManaged Care OrganizationsExclusive Provider Organization