Provider Demographics
NPI:1609680586
Name:PROMINENT COMMUNITY HEALTH AND RESEARCH LLC
Entity type:Organization
Organization Name:PROMINENT COMMUNITY HEALTH AND RESEARCH LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:BABATUNDE
Authorized Official - Middle Name:KING
Authorized Official - Last Name:JIMOH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-413-4131
Mailing Address - Street 1:6490 LANDOVER RD STE D3
Mailing Address - Street 2:
Mailing Address - City:CHEVERLY
Mailing Address - State:MD
Mailing Address - Zip Code:20785-1443
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:6490 LANDOVER RD STE D3
Practice Address - Street 2:
Practice Address - City:CHEVERLY
Practice Address - State:MD
Practice Address - Zip Code:20785-1443
Practice Address - Country:US
Practice Address - Phone:240-413-4131
Practice Address - Fax:704-970-0138
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-02-03
Last Update Date:2025-03-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)