| NPI | 1386399772 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FREDERICK COVINGTON Owner 240-418-0385 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QD1600X Clinic/Center, Developmental Disabilities |
| Additional Taxonomies | 163W00000X Registered Nurse |
| 164W00000X Licensed Practical Nurse | |
| 225100000X Physical Therapist | |
| 225X00000X Occupational Therapist | |
| 251300000X Local Education Agency (LEA) | |
| 251B00000X Case Management | |
| 251C00000X | |
| 251E00000X Home Health | |
| 310500000X Intermediate Care Facility, Mental Illness | |
| 315P00000X Intermediate Care Facility, Intellectual Disabilities | |
| 320600000X Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 320900000X Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities | |
| 343900000X Non-emergency Medical Transport (VAN) | |
| 373H00000X Day Training/Habilitation Specialist | |
| Enumeration Date | 2022-02-15 |
| Last Update Date | 2023-04-13 |