MEDICARE: IT TAKES A VILLAGE, INC.

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	252Y00000X	Early Intervention Provider Agency	2721	DC

General Provider Information

NPI Number	:	1720497738
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	IT TAKES A VILLAGE, INC.

Provider Business Mailing Address
First Line	:	4415 3RD ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-7317
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	4415 3RD ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-7317
Country	:	US
Telephone Number	:	202-423-3939
Fax Number	:	202-726-6779

Authorized Official
Title or Position	:	OWNER
Name	:	YOLANDA LUSANE
Credential	:
Telephone Number	:	202-423-3939

Provider Enumeration Date	:	08/05/2014
Last Update Date	:	08/05/2014

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Directions to “IT TAKES A VILLAGE, INC. ” Practice Location

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