MEDICARE: FAMILY HEALTH CENTER

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	103TA0400X	Addiction (Substance Use Disorder) Psychologist
2	261QM0850X	Adult Mental Health Clinic/Center
3	174400000X	Specialist	LC0295	MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316126121
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	FAMILY HEALTH CENTER

Provider Business Mailing Address
First Line	:	3415 HAMILTON ST
Second Line	:	SUITE 9
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-3953
Country	:	US
Telephone Number	:	301-779-2461
Fax Number	:	301-779-6095

Provider Business Practice Location Address
First Line	:	3415 HAMILTON ST
Second Line	:	SUITE 9
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-3953
Country	:	US
Telephone Number	:	301-779-2461
Fax Number	:	301-779-6095

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	DR. BRUKE TADESSE
Credential	:	PSYD, LCPC, CAS
Telephone Number	:	301-779-2461

Provider Enumeration Date	:	10/29/2007
Last Update Date	:	12/07/2020

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Directions to “FAMILY HEALTH CENTER ” Practice Location

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