MEDICARE: ACT IV

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	251B00000X	Case Management Agency	H423356201579	MD

General Provider Information

NPI Number	:	1316061856
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ACT IV

Provider Business Mailing Address
First Line	:	10005 LAWRENCE POND CT
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-3049
Country	:	US
Telephone Number	:	301-362-1771
Fax Number	:

Provider Business Practice Location Address
First Line	:	10005 LAWRENCE POND CT
Second Line	:
City	:	LAUREL
State	:	MD
Zip	:	20708-3049
Country	:	US
Telephone Number	:	301-362-1771
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR OF ADULT SERVICES
Name	:	MR. CARROLL PARKS
Credential	:
Telephone Number	:	202-698-2525

Provider Enumeration Date	:	03/19/2007
Last Update Date	:	06/16/2008

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Directions to “ACT IV ” Practice Location

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