Provider Demographics
NPI:1669809737
Name:THE 1091 GROUP
Entity type:Organization
Organization Name:THE 1091 GROUP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FOUNDER/OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:IBRAHIM
Authorized Official - Middle Name:TEJAN
Authorized Official - Last Name:KARGBO
Authorized Official - Suffix:
Authorized Official - Credentials:MPH
Authorized Official - Phone:703-798-7826
Mailing Address - Street 1:5810 KINGSTOWNE CENTER DRIVE
Mailing Address - Street 2:#120-146
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22315-5711
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:5810 KINGSTOWNE CENTER DRIVE
Practice Address - Street 2:#120-146
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22315-5711
Practice Address - Country:US
Practice Address - Phone:703-798-7826
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-10-03
Last Update Date:2013-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty