| NPI | 1134095383 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | GAIL ALECIA BOWLES Administrator 301-237-7313 |
| Organization Subpart ? | No |
| Primary Taxonomy | 305R00000X Preferred Provider Organization |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| Enumeration Date | 2025-10-15 |
| Last Update Date | 2025-10-15 |