| NPI | 1285472985 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOSUNMOLA LAKE Medical Director 301-263-4890 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QR0400X Clinic/Center, Rehabilitation |
| Additional Taxonomies | 251E00000X Home Health |
| 261QP2300X Clinic/Center, Primary Care | |
| Enumeration Date | 2024-07-17 |
| Last Update Date | 2024-07-17 |