Provider Demographics
NPI:1417596099
Name:LABIL/ LABYEM LLC.
Entity type:Organization
Organization Name:LABIL/ LABYEM LLC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADMIONISTRATOR
Authorized Official - Prefix:
Authorized Official - First Name:MARIAM
Authorized Official - Middle Name:
Authorized Official - Last Name:OTUNBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-278-1034
Mailing Address - Street 1:9233 MISTING CT
Mailing Address - Street 2:
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603-5724
Mailing Address - Country:US
Mailing Address - Phone:240-278-1034
Mailing Address - Fax:301-638-0109
Practice Address - Street 1:9233 MISTING CT
Practice Address - Street 2:
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603-5724
Practice Address - Country:US
Practice Address - Phone:240-278-1034
Practice Address - Fax:301-638-0108
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-12-31
Last Update Date:2019-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes3140N1450XNursing & Custodial Care FacilitiesSkilled Nursing FacilityNursing Care, Pediatric
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD2722444375Medicaid