Provider Demographics
NPI:1871055616
Name:COMPREHENSIVE INTEGRATED ALLIED HEALTHCARE SERVICES, LLC
Entity type:Organization
Organization Name:COMPREHENSIVE INTEGRATED ALLIED HEALTHCARE SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:ADVANCED NURSE PRACTITIONER
Authorized Official - Prefix:
Authorized Official - First Name:AUGUSTINA
Authorized Official - Middle Name:O
Authorized Official - Last Name:OPEEWE-OJO
Authorized Official - Suffix:
Authorized Official - Credentials:DOCTORATE: NP
Authorized Official - Phone:443-271-3013
Mailing Address - Street 1:3627 OLD MILFORD MILL RD
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-3725
Mailing Address - Country:US
Mailing Address - Phone:443-271-3013
Mailing Address - Fax:
Practice Address - Street 1:6 PARK CENTER CT
Practice Address - Street 2:
Practice Address - City:OWINGS MILLS
Practice Address - State:MD
Practice Address - Zip Code:21117-5601
Practice Address - Country:US
Practice Address - Phone:443-271-3013
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-04-01
Last Update Date:2019-04-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)