Provider Demographics
NPI:1154911196
Name:SPRINGFORTH HEALTH AND WELLNESS CENTER LLC
Entity type:Organization
Organization Name:SPRINGFORTH HEALTH AND WELLNESS CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:NURSE PRACTITIONER/CEO
Authorized Official - Prefix:DR
Authorized Official - First Name:UCHE
Authorized Official - Middle Name:H
Authorized Official - Last Name:FABIKU
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:301-633-2515
Mailing Address - Street 1:11400 TRETON CT
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-1568
Mailing Address - Country:US
Mailing Address - Phone:301-633-2515
Mailing Address - Fax:
Practice Address - Street 1:11400 TRETON CT
Practice Address - Street 2:
Practice Address - City:UPPER MARLBORO
Practice Address - State:MD
Practice Address - Zip Code:20774-1568
Practice Address - Country:US
Practice Address - Phone:301-633-2515
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-01-23
Last Update Date:2021-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamilyGroup - Multi-Specialty
No261QP2300XAmbulatory Health Care FacilitiesClinic/CenterPrimary Care