Provider Demographics
NPI:1205437894
Name:AMC SUPPORT SERVICES
Entity type:Organization
Organization Name:AMC SUPPORT SERVICES
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:KOMRABAI
Authorized Official - Middle Name:OBAI
Authorized Official - Last Name:BANGURA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-413-9916
Mailing Address - Street 1:3475 LEONARDTOWN RD
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-3678
Mailing Address - Country:US
Mailing Address - Phone:240-413-9916
Mailing Address - Fax:
Practice Address - Street 1:3475 LEONARDTOWN RD
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-3678
Practice Address - Country:US
Practice Address - Phone:240-413-9916
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-11-02
Last Update Date:2020-11-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD526475650062Medicaid