MEDICARE: BIANCA JONES-EDELEN

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1194401125
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	BIANCA JONES-EDELEN

Provider Business Mailing Address
First Line	:	3040 BRINKLEY STATION DR
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-6176
Country	:	US
Telephone Number	:	202-421-7521
Fax Number	:

Provider Business Practice Location Address
First Line	:	3040 BRINKLEY STATION DR
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-6176
Country	:	US
Telephone Number	:	202-421-7521
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/26/2023
Last Update Date	:	07/08/2023

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