Healthcare Provider Details

I. General information

NPI: 1023511433
Provider Name (Legal Business Name): NEW PROVIDENCE HEALTHCARE ASSOCIATES INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/12/2018
Last Update Date: 03/12/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5627 ALLENTOWN ROAD 100
CAMP SPRINGS MD
20746-4520
US

IV. Provider business mailing address

145 FLEET ST # 136
OXON HILL MD
20745-1548
US

V. Phone/Fax

Practice location:
  • Phone: 301-241-0255
  • Fax: 240-455-0247
Mailing address:
  • Phone: 301-241-0255
  • Fax: 240-455-0247

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License NumberMH-2432
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code261QM0855X
TaxonomyAdolescent and Children Mental Health Clinic/Center
License NumberMH-2432
License Number StateMD
# 3
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License NumberMH-2432
License Number StateMD
# 4
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH-2432
License Number StateMD
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMH-2431
License Number StateMD

VIII. Authorized Official

Name: XAVIUS DA SILVA - THOMPSON
Title or Position: CFO
Credential:
Phone: 301-241-0255