| Rivers Of Healing Llc | |
|
4311 Hamilton St Hyattsville MD 20781-1937 | |
| (443) 449-8683 | |
| Not Available |
| Full Name | Rivers Of Healing Llc |
|---|---|
| Speciality | Social Worker |
| Location | 4311 Hamilton St, Hyattsville, Maryland |
| Authorized Official Name and Position | Tanya Wagner (OWNER) |
| Authorized Official Contact | 4434498683 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
| Rivers Of Healing Llc 4311 Hamilton St Hyattsville MD 20781-1937 Ph: (443) 449-8683 | Rivers Of Healing Llc 4311 Hamilton St Hyattsville MD 20781-1937 Ph: (443) 449-8683 |
| NPI Number | 1790257939 |
|---|---|
| Provider Enumeration Date | 12/28/2018 |
| Last Update Date | 12/28/2018 |
| Medicare PECOS PAC ID | 6305186925 |
|---|---|
| Medicare Enrollment ID | O20190319000591 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1790257939 | NPI | - | NPPES |
| 1336432749 | Other | MD | INDIVIDUAL NPI |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 1041C0700X | Social Worker - Clinical | (* (Not Available)) | Primary |
| Provider Name | Tanya Wagner |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1336432749 PECOS PAC ID: 7113267733 Enrollment ID: I20190319000770 |
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