MEDICARE: SALLY ALAGOA

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1205490653
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	SALLY ALAGOA

Provider Business Mailing Address
First Line	:	5824 EVERHART PL
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-3011
Country	:	US
Telephone Number	:	301-257-0920
Fax Number	:

Provider Business Practice Location Address
First Line	:	5824 EVERHART PL
Second Line	:
City	:	FORT WASHINGTON
State	:	MD
Zip	:	20744-3011
Country	:	US
Telephone Number	:	301-257-0920
Fax Number	:

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	04/30/2019
Last Update Date	:	04/30/2019

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Directions to “ SALLY ALAGOA ” Practice Location

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