Provider Demographics
NPI:1689493017
Name:AMAZING HEALTHCARE CLINIC CORPORATION
Entity type:Organization
Organization Name:AMAZING HEALTHCARE CLINIC CORPORATION
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROVIDER
Authorized Official - Prefix:
Authorized Official - First Name:BOSEDE
Authorized Official - Middle Name:M
Authorized Official - Last Name:ADELEYE
Authorized Official - Suffix:
Authorized Official - Credentials:PMHNP-BC
Authorized Official - Phone:301-798-5583
Mailing Address - Street 1:10903 N RIDING RD
Mailing Address - Street 2:
Mailing Address - City:UPPER MARLBORO
Mailing Address - State:MD
Mailing Address - Zip Code:20772-8398
Mailing Address - Country:US
Mailing Address - Phone:301-798-5583
Mailing Address - Fax:
Practice Address - Street 1:6495 NEW HAMPSHIRE AVE # A203
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20783-3245
Practice Address - Country:US
Practice Address - Phone:301-798-5583
Practice Address - Fax:301-798-6260
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-03
Last Update Date:2024-10-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health