MEDICARE: INSTITUTE FOR AFRICAN MAN DEVELOPMENT 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	LC302205	DC

General Provider Information

NPI Number	:	1710327606
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	INSTITUTE FOR AFRICAN MAN DEVELOPMENT INC.

Provider Business Mailing Address
First Line	:	2418 HILLSDALE PL SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-4450
Country	:	US
Telephone Number	:	202-271-2457
Fax Number	:

Provider Business Practice Location Address
First Line	:	2418 HILLSDALE PL SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-4450
Country	:	US
Telephone Number	:	202-271-2457
Fax Number	:

Authorized Official
Title or Position	:	FOUNDER/CEO
Name	:	MR. CHESTER LEE MARSHALL
Credential	:	MSW, LICSW
Telephone Number	:	202-271-2457

Provider Enumeration Date	:	06/25/2013
Last Update Date	:	06/25/2013

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