| Sacred Mountains Limited Liability Company | |
|
5503 43rd Ave Hyattsville MD 20781-1906 | |
| (202) 810-1624 | |
| Not Available |
| Full Name | Sacred Mountains Limited Liability Company |
|---|---|
| Speciality | Social Worker - Clinical |
| Location | 5503 43rd Ave, Hyattsville, Maryland |
| Authorized Official Name and Position | Agustin Alfonso Aguirre Herrera (OWNER) |
| Authorized Official Contact | 2028101624 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Sacred Mountains Limited Liability Company 5503 43rd Ave Hyattsville MD 20781-1906 Ph: (202) 810-1624 | Sacred Mountains Limited Liability Company 5503 43rd Ave Hyattsville MD 20781-1906 Ph: (202) 810-1624 |
| NPI Number | 1669231346 |
|---|---|
| Provider Enumeration Date | 03/15/2024 |
| Last Update Date | 03/15/2024 |
| Certification Date | 03/15/2024 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1669231346 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
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