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General NPI Number Information
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NPI Number | 1770734014
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Entity Type | Organization
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Legal Business Name | ICI HOMES LLC
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Dates
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Enumeration Date | 10/06/2008
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Last Update Date | 10/06/2008
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Provider Practice Location Address
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Address Line | 3450 TOLEDO TER # 209
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City | HYATTSVILLE
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State | MD
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Zip | 20782-1397
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Country | US
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Telephone | 201-782-4488
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Fax |
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Provider Business Mailing Address
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Address Line | 7515 ANNAPOLIS RD SUITE 402
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City | HYATTSVILLE
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State | MD
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Zip | 20784-1740
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Country | US
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Telephone | 202-492-8341
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Fax |
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Authorized Official
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Title or Position | PRESIDENT
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Name | MRS. BLESSING I OJUKWU
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Credential |
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Telephone | 202-492-8341
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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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 | DC
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