Healthcare Provider Details

I. General information

NPI: 1366653487
Provider Name (Legal Business Name): PSI SERVICES III, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/24/2007
Last Update Date: 10/25/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

770 M ST SE
WASHINGTON DC
20003-3609
US

IV. Provider business mailing address

7101 WISCONSIN AVE SUITE 1400
BETHESDA MD
20814-4871
US

V. Phone/Fax

Practice location:
  • Phone: 202-547-3870
  • Fax: 202-546-9642
Mailing address:
  • Phone: 301-654-3903
  • Fax: 301-654-4418

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number0020
License Number StateDC

VIII. Authorized Official

Name: MRS. HELEN BACON DORTCH
Title or Position: V.P. FINANCE
Credential:
Phone: 301-654-3903