Provider Demographics
NPI:1154966646
Name:AMAZING HEALTHCARE CLINIC CORPORATION
Entity type:Organization
Organization Name:AMAZING HEALTHCARE CLINIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BOSEDE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADELEYE
Authorized Official - Suffix:
Authorized Official - Credentials:NP
Authorized Official - Phone:301-512-9449
Mailing Address - Street 1:6495 NEW HAMPSHIRE AVE # A203
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20783-3245
Mailing Address - Country:US
Mailing Address - Phone:301-798-5583
Mailing Address - Fax:301-798-6260
Practice Address - Street 1:6495 NEW HAMPSHIRE AVE # A203
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3245
Practice Address - Country:US
Practice Address - Phone:301-798-5583
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-11-08
Last Update Date:2024-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
No251E00000XAgenciesHome Health