Healthcare Provider Details

I. General information

NPI: 1659350767
Provider Name (Legal Business Name): ACCOKEEK COMMUNITY DEVELOPMENT CORP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3070 CRAIN HWY SUITE 102
WALDORF MD
20601-2830
US

IV. Provider business mailing address

3070 CRAIN HWY SUITE 102
WALDORF MD
20601-2830
US

V. Phone/Fax

Practice location:
  • Phone: 301-932-8659
  • Fax: 301-932-7202
Mailing address:
  • Phone: 301-932-8659
  • Fax: 301-932-7202

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MS. TONI HARRIS
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 301-932-8659