Provider Demographics
NPI:1154597755
Name:WESTERN HOWARD COUNTY MOBILE, LLC
Entity type:Organization
Organization Name:WESTERN HOWARD COUNTY MOBILE, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO-OWNER
Authorized Official - Prefix:MRS
Authorized Official - First Name:CHIZOBA
Authorized Official - Middle Name:U
Authorized Official - Last Name:EBINAMA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-745-3513
Mailing Address - Street 1:5084 DORSEY HALL DR
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ELLICOTT CITY
Mailing Address - State:MD
Mailing Address - Zip Code:21042-7891
Mailing Address - Country:US
Mailing Address - Phone:443-745-3513
Mailing Address - Fax:410-992-3509
Practice Address - Street 1:5084 DORSEY HALL DR
Practice Address - Street 2:SUITE 104
Practice Address - City:ELLICOTT CITY
Practice Address - State:MD
Practice Address - Zip Code:21042-7891
Practice Address - Country:US
Practice Address - Phone:443-745-3513
Practice Address - Fax:410-992-3509
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-05-02
Last Update Date:2008-05-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD343900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes343900000XTransportation ServicesNon-emergency Medical Transport (VAN)