Healthcare Provider Details

I. General information

NPI: 1932431848
Provider Name (Legal Business Name): ESA HABILITATION SERVICES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2010
Last Update Date: 02/02/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7200 MORRISON DR
GREENBELT MD
20770-2444
US

IV. Provider business mailing address

7200 MORRISON DR
GREENBELT MD
20770-2444
US

V. Phone/Fax

Practice location:
  • Phone: 240-432-3632
  • Fax: 301-345-6760
Mailing address:
  • Phone: 240-432-3632
  • Fax: 301-345-6760

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License NumberLC302067
License Number StateDC

VIII. Authorized Official

Name: MS. EMILY ANDERSON
Title or Position: CHIEF EXECUTIVE OFFICER
Credential: MSW
Phone: 240-432-3632