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General NPI Number Information
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NPI Number | 1083565220
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Entity Type | Organization
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Legal Business Name | COLOSSAL LIVING
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Dates
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Enumeration Date | 02/04/2026
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Last Update Date | 02/04/2026
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Provider Practice Location Address
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Address Line | 5103 WOODLAND BLVD
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City | OXON HILL
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State | MD
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Zip | 20745-3751
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Country | US
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Telephone | 202-847-8630
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Fax |
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Provider Business Mailing Address
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Address Line | 2105 BELFAST DR
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City | FORT WASHINGTON
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State | MD
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Zip | 20744-3207
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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 | DIRECTOR
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Name | LUKISHA MITCHELL
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Credential |
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Telephone | 202-607-7891
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 324500000X
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Taxonomy Name | Substance Abuse Rehabilitation Facility
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License Number |
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License Number State |
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