=====================================================
General NPI Number Information
=====================================================
NPI Number | 1932452406
-----------------------------------------------------
Entity Type | Organization
-----------------------------------------------------
Legal Business Name | MARY'S CENTER FOR MATERNAL AND CHILD CARE, INC.
-----------------------------------------------------
=====================================================
Dates
=====================================================
Enumeration Date | 10/22/2012
-----------------------------------------------------
Last Update Date | 09/29/2025
-----------------------------------------------------
=====================================================
Provider Practice Location Address
=====================================================
Address Line | 508 KENNEDY ST NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20011-3010
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-483-8196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Provider Business Mailing Address
=====================================================
Address Line | 2333 ONTARIO RD NW
-----------------------------------------------------
City | WASHINGTON
-----------------------------------------------------
State | DC
-----------------------------------------------------
Zip | 20009-2627
-----------------------------------------------------
Country | US
-----------------------------------------------------
Telephone | 202-483-8196
-----------------------------------------------------
Fax |
-----------------------------------------------------
=====================================================
Authorized Official
=====================================================
Title or Position | CHIEF MEDICAL OFFICER
-----------------------------------------------------
Name | MONIQUE MARGARETA POWELL-DAVIS
-----------------------------------------------------
Credential |
-----------------------------------------------------
Telephone | 202-424-2655
-----------------------------------------------------
=====================================================
Scope of Practice (Provider's specialty)
=====================================================
Taxonomy #1
-----------------------------------------------------
Taxonomy Code | 261QF0400X
-----------------------------------------------------
Taxonomy Name | Federally Qualified Health Center (FQHC)
-----------------------------------------------------
License Number |
-----------------------------------------------------
License Number State |
-----------------------------------------------------