| Trinity Detox And Family Clinic,inc. | |
|
1232 Race Rd Ste 302 Rosedale MD 21237-2382 | |
| (443) 326-0503 | |
| Not Available |
| Full Name | Trinity Detox And Family Clinic,inc. |
|---|---|
| Speciality | Nurse Practitioner |
| Location | 1232 Race Rd Ste 302, Rosedale, Maryland |
| Authorized Official Name and Position | Ifeyinwa Cordelia Ibeanu (FAMILY NURSE PRACTITIONER/PROVIDER) |
| Authorized Official Contact | 4433260503 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Trinity Detox And Family Clinic,inc. 1232 Race Rd Ste 302 Rosedale MD 21237-2382 Ph: (443) 326-0503 | Trinity Detox And Family Clinic,inc. 1232 Race Rd Ste 302 Rosedale MD 21237-2382 Ph: (443) 326-0503 |
| NPI Number | 1295386233 |
|---|---|
| Provider Enumeration Date | 09/20/2019 |
| Last Update Date | 09/04/2020 |
| Medicare PECOS PAC ID | 4789915521 |
|---|---|
| Medicare Enrollment ID | O20191009002648 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1295386233 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 207R00000X | Internal Medicine | (* (Not Available)) | Secondary |
| 363LF0000X | Nurse Practitioner - Family | (* (Not Available)) | Primary |
| Provider Name | Ifeyinwa C Ibeanu |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1902351430 PECOS PAC ID: 3779815295 Enrollment ID: I20191101000165 |
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