Provider Demographics
NPI:1871088641
Name:ACT HEALTH INTEGRATED SERVICES, LLC
Entity type:Organization
Organization Name:ACT HEALTH INTEGRATED SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:FAMILY NURSE PRACTITIONER
Authorized Official - Prefix:DR
Authorized Official - First Name:MARY
Authorized Official - Middle Name:FOWAAH
Authorized Official - Last Name:BOATENG
Authorized Official - Suffix:
Authorized Official - Credentials:DNP
Authorized Official - Phone:301-679-5770
Mailing Address - Street 1:800 S FREDERICK AVE STE 208
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4152
Mailing Address - Country:US
Mailing Address - Phone:301-679-5770
Mailing Address - Fax:301-235-1520
Practice Address - Street 1:800 S FREDERICK AVE STE 208
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4152
Practice Address - Country:US
Practice Address - Phone:301-679-5770
Practice Address - Fax:301-235-1520
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-06-25
Last Update Date:2023-09-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDR214992261QM1300X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty