Provider Demographics
NPI:1124775861
Name:R I C HEALTH SERVICES LLC
Entity type:Organization
Organization Name:R I C HEALTH SERVICES LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:
Authorized Official - First Name:RUPHINA
Authorized Official - Middle Name:
Authorized Official - Last Name:NNEBEDUM
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:240-374-2906
Mailing Address - Street 1:10706 BIRDIE LN
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-6019
Mailing Address - Country:US
Mailing Address - Phone:240-493-4704
Mailing Address - Fax:301-753-7003
Practice Address - Street 1:1300 MERCANTILE LN STE 100C
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5383
Practice Address - Country:US
Practice Address - Phone:301-278-2626
Practice Address - Fax:497-986-8609
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-03-02
Last Update Date:2022-07-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)