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General NPI Number Information
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NPI Number | 1417879420
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Entity Type | Organization
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Legal Business Name | COMMUNITY BASED SEVICES PRP AT EQUANIMITY
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Dates
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Enumeration Date | 07/29/2026
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Last Update Date | 07/29/2026
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Provider Practice Location Address
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Address Line | 10665 STANHAVEN PL
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City | WHITE PLAINS
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State | MD
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Zip | 20695-3055
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Country | US
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Telephone | 404-980-4808
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Fax | 240-241-6360
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Provider Business Mailing Address
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Address Line | 10665 STANHAVEN PL
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City | WHITE PLAINS
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State | MD
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Zip | 20695-3055
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Country | US
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Telephone | 404-980-4808
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Fax | 240-241-6360
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Authorized Official
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Title or Position | MEMBER
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Name | MR. TAVIN PARKER
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Credential |
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Telephone | 404-980-4808
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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