Healthcare Provider Details

I. General information

NPI: 1023356847
Provider Name (Legal Business Name): FAMILY SERVICES, INC/THE SUPPORT CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2013
Last Update Date: 01/29/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 GRANDIN AVE
ROCKVILLE MD
20851-1300
US

IV. Provider business mailing address

1010 GRANDIN AVE
ROCKVILLE MD
20851-1300
US

V. Phone/Fax

Practice location:
  • Phone: 301-738-2250
  • Fax: 301-309-1797
Mailing address:
  • Phone: 301-738-2250
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number15 007 C
License Number StateMD

VIII. Authorized Official

Name: PAULETTE JACQUELINE CRADDOCK
Title or Position: PROGRAM DIRECTOR
Credential: RN BSN
Phone: 301-738-2250