Provider Demographics
NPI:1720617525
Name:SQUADRON HEALTH ENTERPRISES, LLC
Entity Type:Organization
Organization Name:SQUADRON HEALTH ENTERPRISES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:J
Authorized Official - Last Name:DONOVAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-746-6136
Mailing Address - Street 1:11110 SUNSET HILLS RD UNIT 8124
Mailing Address - Street 2:
Mailing Address - City:RESTON
Mailing Address - State:VA
Mailing Address - Zip Code:20195-8091
Mailing Address - Country:US
Mailing Address - Phone:202-746-6136
Mailing Address - Fax:
Practice Address - Street 1:10602 ALLENWOOD LN
Practice Address - Street 2:
Practice Address - City:GREAT FALLS
Practice Address - State:VA
Practice Address - Zip Code:22066-3229
Practice Address - Country:US
Practice Address - Phone:202-262-0748
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-04-03
Last Update Date:2020-04-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes208D00000XAllopathic & Osteopathic PhysiciansGeneral PracticeGroup - Multi-Specialty