Provider Demographics
NPI:1043067655
Name:ISB COMMUNITY HEALTH CLINIC
Entity type:Organization
Organization Name:ISB COMMUNITY HEALTH CLINIC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRACTICE MANAGER
Authorized Official - Prefix:MS
Authorized Official - First Name:FAJR
Authorized Official - Middle Name:
Authorized Official - Last Name:KHOKHAR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:667-802-0425
Mailing Address - Street 1:6631 JOHNNYCAKE RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-2401
Mailing Address - Country:US
Mailing Address - Phone:410-744-1690
Mailing Address - Fax:410-744-1691
Practice Address - Street 1:6623 JOHNNYCAKE RD
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-2401
Practice Address - Country:US
Practice Address - Phone:410-744-1690
Practice Address - Fax:410-744-1691
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:ISLAMIC SOCIETY OF BALTIMORE, MD, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2024-05-01
Last Update Date:2024-05-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QP2000XAmbulatory Health Care FacilitiesClinic/CenterPhysical Therapy