| Blessed Vine Healthcare Services Llc | |
|
3261 Old Washington Rd Ste 2020 Waldorf MD 20602-3231 | |
| (240) 725-4037 | |
| Not Available |
| Full Name | Blessed Vine Healthcare Services Llc |
|---|---|
| Speciality | Clinic/Center |
| Location | 3261 Old Washington Rd Ste 2020, Waldorf, Maryland |
| Authorized Official Name and Position | Barbara Buxton (OWNER) |
| Authorized Official Contact | 2407254037 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Blessed Vine Healthcare Services Llc 3261 Old Washington Rd Ste 2020 Waldorf MD 20602-3231 Ph: (240) 725-4037 | Blessed Vine Healthcare Services Llc 3261 Old Washington Rd Ste 2020 Waldorf MD 20602-3231 Ph: (240) 725-4037 |
| NPI Number | 1619799459 |
|---|---|
| Provider Enumeration Date | 10/31/2024 |
| Last Update Date | 10/31/2024 |
| Certification Date | 10/24/2024 |
| Medicare PECOS PAC ID | 8921535659 |
|---|---|
| Medicare Enrollment ID | O20241219001816 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1619799459 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
| Provider Name | Barbara Buxton |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1801567052 PECOS PAC ID: 9830626563 Enrollment ID: I20241219001974 |
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