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General NPI Number Information
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NPI Number | 1386879955
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Entity Type | Organization
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Legal Business Name | 11714 TUSCANY DRIVE
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Dates
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Enumeration Date | 05/26/2009
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Last Update Date | 05/26/2009
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Provider Practice Location Address
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Address Line | 11714 TUSCANY DR
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City | LAUREL
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State | MD
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Zip | 20708-2841
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Country | US
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Telephone | 301-332-7222
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Fax |
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Provider Business Mailing Address
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Address Line | 11714 TUSCANY DR
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City | LAUREL
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State | MD
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Zip | 20708-2841
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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 | ADMINISTRATOR
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Name | NGOZI MARYANN OKUDOH
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Credential |
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Telephone | 301-332-7222
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 373H00000X
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Taxonomy Name | Day Training/Habilitation Specialist
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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 | 320900000X
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Taxonomy Name | Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
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License Number |
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License Number State |
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