# ADVANCE INTEGRATED HEALTH, LLC

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

## Provider details

- **NPI number:** 1952934671
- **Authorized official:** DEBORAH KESEWAH KOROMA CRNP (NURSE PRACTITIONER)
- **Authorized official phone:** (301) 978-1990

## Contact information

- **Practice address:** 16204 PENTERRA WAY, BOWIE, MD 20716-1919
- **Practice address phone:** (301) 978-1990
- **Mailing address:** 16204 PENTERRA WAY, BOWIE, MD 20716-1919
- **Mailing address phone:** (301) 978-1990

## Taxonomy

| Code | Description | License number | State | Primary |
| --- | --- | --- | --- | --- |
| 251S00000X | Community/Behavioral Health Agency | — | NULL | — |
| 261QM0801X | Mental Health Clinic/Center (Including Community Mental Health Center) | — | NULL | — |
| 261QM1300X | Multi-Specialty Clinic/Center | — | NULL | Yes |
| 261QP2300X | Primary Care Clinic/Center | — | NULL | — |

## Other

- **Enumeration date:** 02/20/2020
- **Last updated:** 02/20/2020