MEDICARE: ROBERTA'S DEVELOPMENTAL DISABILITY CTR.

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	385H00000X	Respite Care		DC

General Provider Information

NPI Number	:	1699931733
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	ROBERTA'S DEVELOPMENTAL DISABILITY CTR.

Provider Business Mailing Address
First Line	:	PO BOX 993
Second Line	:
City	:	OXON HILL
State	:	MD
Zip	:	20750-0993
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	2012 HIGH TIMBER RD
Second Line	:
City	:	FT WASHINGTON
State	:	MD
Zip	:	20744-3125
Country	:	US
Telephone Number	:	301-233-1314
Fax Number	:

Authorized Official
Title or Position	:	OWNER
Name	:	MS. ROBERTA MUMFORD
Credential	:
Telephone Number	:	301-233-1314

Provider Enumeration Date	:	07/29/2008
Last Update Date	:	07/29/2008

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