Healthcare Provider Details

I. General information

NPI: 1285305292
Provider Name (Legal Business Name): PSI SERVICES III, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/21/2021
Last Update Date: 09/24/2021
Certification Date: 09/24/2021
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 Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: SHAWN RUBBIN
Title or Position: EXECUTIVE OFFICER
Credential:
Phone: 301-552-7120