Healthcare Provider Details

I. General information

NPI: 1992164966
Provider Name (Legal Business Name): MARY'S CENTER FOR MATERNAL AND CHILD CARE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/18/2016
Last Update Date: 04/27/2026
Certification Date: 04/27/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

100 GALLATIN ST NE
WASHINGTON DC
20011-7517
US

IV. Provider business mailing address

2333 ONTARIO RD NW
WASHINGTON DC
20009-2627
US

V. Phone/Fax

Practice location:
  • Phone: 202-483-8196
  • Fax: 202-420-7164
Mailing address:
  • Phone: 202-420-7175
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number64001664
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State

VIII. Authorized Official

Name: NANCY BAN
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 202-483-8196