| NPI | 1609450576 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MOSUNMOLA SANDRA LAKE Manager 301-272-1558 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QM0801X |
| Additional Taxonomies | 251S00000X Community/Behavioral Health |
| 261QR0800X Clinic/Center, Recovery Care | |
| 283Q00000X Psychiatric Hospital | |
| Enumeration Date | 2021-05-07 |
| Last Update Date | 2024-02-13 |