Provider Demographics
NPI:1831527183
Name:MANSFIELD KASEMAN HEALTH CLINIC, LLC
Entity type:Organization
Organization Name:MANSFIELD KASEMAN HEALTH CLINIC, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SARAH
Authorized Official - Middle Name:
Authorized Official - Last Name:BASEHART
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-917-6806
Mailing Address - Street 1:9420 KEY WEST AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-6327
Mailing Address - Country:US
Mailing Address - Phone:301-917-6800
Mailing Address - Fax:301-917-6810
Practice Address - Street 1:9420 KEY WEST AVE STE 400
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-6327
Practice Address - Country:US
Practice Address - Phone:301-917-6800
Practice Address - Fax:301-917-6810
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY REACH OF MONTGOMERY COUNTY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-10-24
Last Update Date:2024-11-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
261Q00000X
MDAC000765261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center