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General NPI Number Information
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NPI Number | 1023975026
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Entity Type | Organization
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Legal Business Name | CN SBHC FAIRMONT HEIGHTS HS
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Dates
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Enumeration Date | 01/09/2026
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Last Update Date | 01/09/2026
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Provider Practice Location Address
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Address Line | 6501 COLUMBIA PARK RD
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City | LANDOVER
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State | MD
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Zip | 20785-3970
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Country | US
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Telephone | 301-749-4722
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Fax |
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Provider Business Mailing Address
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Address Line | 111 MICHIGAN AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20010-2916
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | VP - PAYOR FINANCIAL RELATIONS
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Name | PHILLICIA NELSON
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Credential |
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Telephone | 301-572-6281
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD0000X
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Taxonomy Name | Dental Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QS1000X
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Taxonomy Name | Student Health Clinic/Center
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License Number |
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License Number State |
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