MEDICARE: NEW PROVIDENCE HEALTHCARE ASSOCIATES INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	251S00000X	Community/Behavioral Health Agency	MH-2431	MD
2	261QM0850X	Adult Mental Health Clinic/Center	MH-2432	MD
3	261QM0855X	Adolescent and Children Mental Health Clinic/Center	MH-2432	MD
4	261QM1300X	Multi-Specialty Clinic/Center	MH-2432	MD
5	251S00000X	Community/Behavioral Health Agency	MH-2432	MD

General Provider Information

NPI Number	:	1023511433
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NEW PROVIDENCE HEALTHCARE ASSOCIATES INC.

Provider Business Mailing Address
First Line	:	145 FLEET ST # 136
Second Line	:
City	:	OXON HILL
State	:	MD
Zip	:	20745-1548
Country	:	US
Telephone Number	:	301-241-0255
Fax Number	:	240-455-0247

Provider Business Practice Location Address
First Line	:	5627 ALLENTOWN ROAD
Second Line	:	100
City	:	CAMP SPRINGS
State	:	MD
Zip	:	20746-4520
Country	:	US
Telephone Number	:	301-241-0255
Fax Number	:	240-455-0247

Authorized Official
Title or Position	:	CFO
Name	:	XAVIUS DA SILVA - THOMPSON
Credential	:
Telephone Number	:	301-241-0255

Provider Enumeration Date	:	03/12/2018
Last Update Date	:	03/12/2018

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