| Gilgal Group Pa | |
|
5205 East Dr Ste H Arbutus MD 21227-2403 | |
| (443) 631-3878 | |
| Not Available |
| Full Name | Gilgal Group Pa |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 5205 East Dr Ste H, Arbutus, Maryland |
| Authorized Official Name and Position | Frederick Olumide Kumolalo (CEO/PROGRAM ADMINISTRATOR) |
| Authorized Official Contact | 4436313878 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Gilgal Group Pa 5205 East Dr Ste H Arbutus MD 21227-2403 Ph: (443) 631-3878 | Gilgal Group Pa 5205 East Dr Ste H Arbutus MD 21227-2403 Ph: (443) 631-3878 |
| NPI Number | 1790345270 |
|---|---|
| Provider Enumeration Date | 06/18/2019 |
| Last Update Date | 06/18/2019 |
| Medicare PECOS PAC ID | 0749601888 |
|---|---|
| Medicare Enrollment ID | O20200528001412 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790345270 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | (* (Not Available)) | Primary |
| Provider Name | Helen T Kumolalo |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1497995286 PECOS PAC ID: 4880873157 Enrollment ID: I20110119001036 |
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