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General NPI Number Information
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NPI Number | 1558874040
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Entity Type | Organization
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Legal Business Name | IJOMAH AND ASSOCIATES INC
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Dates
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Enumeration Date | 11/07/2017
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Last Update Date | 11/07/2017
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Provider Practice Location Address
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Address Line | 3050 OLD WASHINGTON RD
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City | WALDORF
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State | MD
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Zip | 20601-3121
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Country | US
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Telephone | 301-642-8468
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Fax | 301-642-8468
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Provider Business Mailing Address
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Address Line | 4607 69TH AVE
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City | HYATTSVILLE
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State | MD
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Zip | 20784-2123
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Country | US
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Telephone | 301-642-8468
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | VERNESSA SCURRY
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Credential |
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Telephone | 301-642-8468
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 323P00000X
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Taxonomy Name | Psychiatric Residential Treatment Facility
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License Number |
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License Number State |
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