Healthcare Provider Details

I. General information

NPI: 1699958348
Provider Name (Legal Business Name): EBED COMMUNTIY IMPROVEMENT INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 12/17/2007
Last Update Date: 12/17/2007
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4487 FORBES BLVD
LANHAM MD
20706-4354
US

IV. Provider business mailing address

4487 FORBES BLVD
LANHAM MD
20706-4354
US

V. Phone/Fax

Practice location:
  • Phone: 301-306-1050
  • Fax:
Mailing address:
  • Phone: 301-306-1050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number039138700
License Number StateDC

VIII. Authorized Official

Name: MRS. RHONDA ALANE GRAHAM
Title or Position: CEO
Credential:
Phone: 301-306-1050