Provider Demographics
NPI:1184469579
Name:GAMBRILLS SISTERS HEALTH CARE SERVICES LLC
Entity type:Organization
Organization Name:GAMBRILLS SISTERS HEALTH CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:FATU
Authorized Official - Middle Name:
Authorized Official - Last Name:KOROMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-437-2705
Mailing Address - Street 1:106 CALUMET CT
Mailing Address - Street 2:
Mailing Address - City:GAMBRILLS
Mailing Address - State:MD
Mailing Address - Zip Code:21054-1060
Mailing Address - Country:US
Mailing Address - Phone:240-437-2705
Mailing Address - Fax:
Practice Address - Street 1:6490 LANDOVER RD
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1443
Practice Address - Country:US
Practice Address - Phone:240-437-2705
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:GAMBRILLS SISTERS HEALTH CARE
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-06-27
Last Update Date:2024-07-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Multi-Specialty