MEDICARE: ERHKY THERAPEUTIC SERVICES

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	1041C0700X	Clinical Social Worker	LG50077952	MD

General Provider Information

NPI Number	:	1043516339
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ERHKY THERAPEUTIC SERVICES

Provider Business Mailing Address
First Line	:	4833 SAINT BARNABAS RD
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-4658
Country	:	US
Telephone Number	:	301-424-1904
Fax Number	:	301-423-4167

Provider Business Practice Location Address
First Line	:	4833 SAINT BARNABAS RD
Second Line	:
City	:	TEMPLE HILLS
State	:	MD
Zip	:	20748-4658
Country	:	US
Telephone Number	:	301-424-1904
Fax Number	:	301-423-4167

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	ERIC R HURLEY
Credential	:
Telephone Number	:	301-423-1904

Provider Enumeration Date	:	02/03/2011
Last Update Date	:	02/03/2011

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