# BALI HEALTHCARE, INC.

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- **Entity:** Organization
- **Status:** Active
- **Organization subpart:** No

## Provider details

- **NPI number:** 1699105395
- **Authorized official:** ALFRED SIBEDWO (PRESIDENT/CEO)
- **Authorized official phone:** (301) 364-3300

## Contact information

- **Practice address:** 1841 BRIGHTSEAT RD, LANDOVER, MD 20785-4250
- **Practice address phone:** (301) 364-3300
- **Practice address fax:** (301) 364-3305
- **Mailing address:** PO BOX 6854, LARGO, MD 20792-6854
- **Mailing address phone:** (301) 364-3300
- **Mailing address fax:** (301) 364-3305

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 207Q00000X | Family Medicine Physician | D0052015 | MD | Yes |
| 2084P0800X | Psychiatry Physician | D0052015 | MD | — |

## Other

- **Enumeration date:** 11/15/2013
- **Last updated:** 11/19/2013