Healthcare Provider Details

I. General information

NPI: 1053053447
Provider Name (Legal Business Name): PROFESSIONAL SERVICES OF HOLY CROSS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/07/2022
Last Update Date: 04/07/2022
Certification Date: 04/07/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

10720 COLUMBIA PIKE STE 300
SILVER SPRING MD
20901-4455
US

IV. Provider business mailing address

PO BOX 531863
ATLANTA GA
30353-1863
US

V. Phone/Fax

Practice location:
  • Phone: 301-557-1231
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code163WD0400X
TaxonomyDiabetes Educator Registered Nurse
License Number
License Number State

VIII. Authorized Official

Name: ANNE GILLIS
Title or Position: CFO
Credential:
Phone: 301-754-7035