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General NPI Number Information
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NPI Number | 1023414828
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Entity Type | Organization
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Legal Business Name | STILL I RISE, INC
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Dates
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Enumeration Date | 11/06/2014
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Last Update Date | 11/06/2014
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Provider Practice Location Address
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Address Line | 9023 WOODYARD RD
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City | CLINTON
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State | MD
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Zip | 20735-4208
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Country | US
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Telephone | 301-868-4903
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Fax |
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Provider Business Mailing Address
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Address Line | 9015 WOODYARD RD
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City | CLINTON
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State | MD
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Zip | 20735-4209
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Country | US
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Telephone | 301-868-4903
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Fax |
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Authorized Official
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Title or Position | CEO
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Name | DR. GLENDA F HODGES
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Credential |
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Telephone | 301-868-4903
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2300X
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Taxonomy Name | Primary Care Clinic/Center
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License Number | 261QP2300X
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License Number State | MD
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