| NPI | 1205615739 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | THERESA ANTIONETTE JACKSON A/R Billing Coordinator 301-586-0900 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 261QM0801X |
| Enumeration Date | 2023-09-25 |
| Last Update Date | 2023-09-26 |