Healthcare Provider Details

I. General information

NPI: 1992348635
Provider Name (Legal Business Name): COMMUNITY THERAPEUTIC CENTER,INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/25/2019
Last Update Date: 05/19/2021
Certification Date: 05/19/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4325 FORBES BLVD STE A
LANHAM MD
20706-4853
US

IV. Provider business mailing address

4325 FORBES BLVD STE A
LANHAM MD
20706-4853
US

V. Phone/Fax

Practice location:
  • Phone: 240-764-5133
  • Fax:
Mailing address:
  • Phone: 240-764-5133
  • 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: EMMANUEL OWOOJE
Title or Position: PRESIDENT
Credential:
Phone: 240-240-5133