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NPI Code Detail

MEDICARE: SURVIVOR SOURCES INC

MEDICARE: SURVIVOR SOURCES 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
1171M00000XCase Manager/Care Coordinator
2251C00000XDevelopmentally Disabled Services Day Training Agency
3363LF0000XFamily Nurse Practitioner
4363LX0001XObstetrics & Gynecology Nurse Practitioner
5261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1174160980
Entity Type Code : Organization
Provider Name (Legal Business Name) : SURVIVOR SOURCES INC
Provider Business Mailing Address
First Line : 4301 GARDEN CITY DR STE 304
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20785-6105
Country : US
Telephone Number : 301-235-0060
Fax Number :
Provider Business Practice Location Address
First Line : 4301 GARDEN CITY DR STE 304
Second Line :
City : HYATTSVILLE
State : MD
Zip : 20785-6105
Country : US
Telephone Number : 301-235-0060
Fax Number :
Authorized Official
Title or Position : CHAIRMAN
Name : DR. MARSHALEE GEORGE
Credential :
Telephone Number : 443-453-3343
Provider Enumeration Date : 11/30/2019
Last Update Date : 11/13/2020

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Directions to “SURVIVOR SOURCES INC ” Practice Location

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