Healthcare Provider Details

I. General information

NPI: 1053036640
Provider Name (Legal Business Name): ABREAST THERAPEUTIC CENTER, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/06/2022
Last Update Date: 01/27/2023
Certification Date: 01/26/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9418 ANNAPOLIS RD STE 202
LANHAM MD
20706-3053
US

IV. Provider business mailing address

9418 ANNAPOLIS RD STE 200
LANHAM MD
20706-3052
US

V. Phone/Fax

Practice location:
  • Phone: 240-764-5180
  • Fax:
Mailing address:
  • Phone: 240-764-5180
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code261QM2500X
TaxonomyMedical Specialty Clinic/Center
License Number
License Number StateNULL
# 3
Primary TaxonomyN
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number
License Number StateNULL
# 4
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateNULL
# 5
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. ABAYOMI SOKOYA
Title or Position: PRESIDENT
Credential:
Phone: 240-764-5180