Provider Demographics
NPI:1376372540
Name:EMINENT HEALTHCARE
Entity type:Organization
Organization Name:EMINENT HEALTHCARE
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:ADEBOWALE
Authorized Official - Last Name:OGIDIOLU
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-985-5493
Mailing Address - Street 1:10560 MAIN ST STE 98-8
Mailing Address - Street 2:
Mailing Address - City:FAIRFAX
Mailing Address - State:VA
Mailing Address - Zip Code:22030-7132
Mailing Address - Country:US
Mailing Address - Phone:443-985-5493
Mailing Address - Fax:410-501-5140
Practice Address - Street 1:10560 MAIN ST STE 98-8
Practice Address - Street 2:
Practice Address - City:FAIRFAX
Practice Address - State:VA
Practice Address - Zip Code:22030-7132
Practice Address - Country:US
Practice Address - Phone:443-985-5493
Practice Address - Fax:410-501-5140
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-07-29
Last Update Date:2024-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities