1437273372 NPI number — GUIDE PROGRAM, INC

Table of content: (NPI 1437273372)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1437273372 NPI number — GUIDE PROGRAM, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
GUIDE PROGRAM, INC
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
GUIDE INDEPENDENCE PRP - PRINCE GEORGE'S
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1437273372
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8643 CHERRY LN
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LAUREL
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20707-6200
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-549-3602
Provider Business Mailing Address Fax Number:
301-549-3605

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5508 KAREN ELAINE DR
Provider Second Line Business Practice Location Address:
824
Provider Business Practice Location Address City Name:
NEW CARROLLTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20784-4131
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-459-8220
Provider Business Practice Location Address Fax Number:
301-577-1756
Provider Enumeration Date:
03/18/2007

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
BIRDSONG
Authorized Official First Name:
SCOTT
Authorized Official Middle Name:
K.
Authorized Official Title or Position:
EXECUTIVE DIRECTOR & PRESIDENT
Authorized Official Telephone Number:
301-549-3602

Provider Taxonomy Codes

  • Taxonomy code: 261QM0801X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)