Healthcare Provider Details

I. General information

NPI: 1114399862
Provider Name (Legal Business Name): PSI SERVICES III, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/21/2015
Last Update Date: 08/21/2020
Certification Date: 08/21/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5820 DIX ST NE
WASHINGTON DC
20019-6965
US

IV. Provider business mailing address

8301 PROFESSIONAL PL STE 205
HYATTSVILLE MD
20785-2353
US

V. Phone/Fax

Practice location:
  • Phone: 202-547-3870
  • Fax:
Mailing address:
  • Phone: 301-552-7120
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: DR. YVONNE BRUNTON ALI
Title or Position: PRESIDENT
Credential: PH.D.
Phone: 202-547-3870