| Innovation Health System, Llc | |
|
2138 Espey Ct Ste 1 Crofton MD 21114-2495 | |
| (443) 470-7916 | |
| (443) 470-7718 |
| Full Name | Innovation Health System, Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 2138 Espey Ct Ste 1, Crofton, Maryland |
| Authorized Official Name and Position | Richard Nkwetta (OWNER) |
| Authorized Official Contact | 4434707916 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Innovation Health System, Llc 2138 Espey Ct Ste 1 Crofton MD 21114-2495 Ph: (443) 470-7916 | Innovation Health System, Llc 2138 Espey Ct Ste 1 Crofton MD 21114-2495 Ph: (443) 470-7916 |
| NPI Number | 1548091838 |
|---|---|
| Provider Enumeration Date | 08/09/2024 |
| Last Update Date | 08/09/2024 |
| Certification Date | 08/09/2024 |
| Medicare PECOS PAC ID | 0648704288 |
|---|---|
| Medicare Enrollment ID | O20241105003102 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1548091838 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Richard Asah Nkwetta |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1669124731 PECOS PAC ID: 8729221718 Enrollment ID: I20241105003248 |
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