Provider Demographics
NPI:1487771382
Name:KELIZ LLC
Entity type:Organization
Organization Name:KELIZ LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:OCTAVIE
Authorized Official - Middle Name:B
Authorized Official - Last Name:BONGAM-SIKOD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-294-4558
Mailing Address - Street 1:9902 WOODYARD CIR
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-4326
Mailing Address - Country:US
Mailing Address - Phone:240-505-5356
Mailing Address - Fax:301-877-7966
Practice Address - Street 1:6856 EASTERN AVE NW STE 376D
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20012-2178
Practice Address - Country:US
Practice Address - Phone:202-294-4558
Practice Address - Fax:202-450-2125
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-23
Last Update Date:2011-10-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCNSA-0180251J00000X
DC332B00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes332B00000XSuppliersDurable Medical Equipment & Medical Supplies
No251J00000XAgenciesNursing Care