Healthcare Provider Details

I. General information

NPI: 1982809760
Provider Name (Legal Business Name): FAMILY TRAUMA SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/20/2007
Last Update Date: 06/17/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9470 ANNAPOLIS RD SUITE 209
LANHAM MD
20706-3025
US

IV. Provider business mailing address

PO BOX 2065
ROCKVILLE MD
20847-2065
US

V. Phone/Fax

Practice location:
  • Phone: 301-306-6306
  • Fax: 301-306-6304
Mailing address:
  • Phone: 301-306-6306
  • Fax: 301-306-6306

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number StateMD

VIII. Authorized Official

Name: WAYNE D PARKS
Title or Position: DIRECTOR
Credential:
Phone: 301-306-6306