Healthcare Provider Details

I. General information

NPI: 1336181775
Provider Name (Legal Business Name): HEAD INJURY REHABILITATION AND REFERRAL SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/11/2006
Last Update Date: 04/10/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

11 TAFT CT STE 100
ROCKVILLE MD
20850-5350
US

IV. Provider business mailing address

11 TAFT CT STE 100
ROCKVILLE MD
20850-5350
US

V. Phone/Fax

Practice location:
  • Phone: 301-309-2228
  • Fax: 301-309-2278
Mailing address:
  • Phone: 301-309-2228
  • Fax: 301-309-2278

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberDDA3795-98
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License NumberDDA-29155
License Number StateMD
# 3
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberDDA-29155
License Number StateMD

VIII. Authorized Official

Name: RICARDO HUNTER
Title or Position: PRESIDENT
Credential:
Phone: 301-309-2228