Provider Demographics
NPI:1912734120
Name:PRINCEWELL LLC
Entity type:Organization
Organization Name:PRINCEWELL LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:ADENIYI
Authorized Official - Middle Name:ABAYOMI
Authorized Official - Last Name:OYEBANJO-GEORGE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-535-5080
Mailing Address - Street 1:507 JACQUE CT
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20721-7241
Mailing Address - Country:US
Mailing Address - Phone:240-535-5080
Mailing Address - Fax:
Practice Address - Street 1:507 JACQUE CT
Practice Address - Street 2:
Practice Address - City:BOWIE
Practice Address - State:MD
Practice Address - Zip Code:20721-7241
Practice Address - Country:US
Practice Address - Phone:240-535-5080
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-09-19
Last Update Date:2024-09-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No101YP2500XBehavioral Health & Social Service ProvidersCounselorProfessionalGroup - Multi-Specialty
No251E00000XAgenciesHome Health
No251S00000XAgenciesCommunity/Behavioral Health