Provider Demographics
NPI:1083411136
Name:HUMANENESS PROVIDER CARE SERVICES LLC
Entity type:Organization
Organization Name:HUMANENESS PROVIDER CARE SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FNP
Authorized Official - Prefix:
Authorized Official - First Name:MUSU
Authorized Official - Middle Name:
Authorized Official - Last Name:KOMEYAN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-344-2023
Mailing Address - Street 1:12701 WOODMORE RD
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-4121
Mailing Address - Country:US
Mailing Address - Phone:301-344-2023
Mailing Address - Fax:
Practice Address - Street 1:9061 EARLY APRIL WAY
Practice Address - Street 2:
Practice Address - City:COLUMBIA
Practice Address - State:MD
Practice Address - Zip Code:21046-1474
Practice Address - Country:US
Practice Address - Phone:301-344-2023
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-26
Last Update Date:2025-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty