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General NPI Number Information
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NPI Number | 1558999896
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Entity Type | Organization
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Legal Business Name | OUR EMMANUEL LNC
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Dates
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Enumeration Date | 03/31/2020
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Last Update Date | 03/31/2020
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Provider Practice Location Address
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Address Line | 2301 GEORGIA AVE NW STE D
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City | WASHINGTON
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State | DC
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Zip | 20001-3000
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Country | US
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Telephone | 202-996-0125
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Fax |
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Provider Business Mailing Address
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Address Line | 5639 ANNAPOLIS RD
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City | BLADENSBURG
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State | MD
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Zip | 20710-2212
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Country | US
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Telephone | 301-699-3344
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Fax |
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Authorized Official
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Title or Position | COO
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Name | OLADAPO DANIEL ADEYALE
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Credential |
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Telephone | 301-256-4724
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QD1600X
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Taxonomy Name | Developmental Disabilities Clinic/Center
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License Number |
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License Number State |
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