1770871246 NPI number — CENTER FOR COMPREHENSIVE SERVICES

Table of content: (NPI 1770871246)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770871246 NPI number — CENTER FOR COMPREHENSIVE SERVICES

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CENTER FOR COMPREHENSIVE SERVICES
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:
NEURORESTORATIVE MARYLAND
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:
1770871246
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/18/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
10150 HIGHLAND MANOR DR
Provider Second Line Business Mailing Address:
SUITE 140
Provider Business Mailing Address City Name:
TAMPA
Provider Business Mailing Address State Name:
FL
Provider Business Mailing Address Postal Code:
33610-9713
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
813-626-1444
Provider Business Mailing Address Fax Number:
813-621-0770

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
12312 MILLSTREAM DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BOWIE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20715-1547
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-352-2979
Provider Business Practice Location Address Fax Number:
301-262-6089
Provider Enumeration Date:
07/18/2011

Additional Information

Authorized Official

Authorized Official Last Name:
JOHNSON-WILLIAMS
Authorized Official First Name:
LOREYONNA
Authorized Official Middle Name:
S
Authorized Official Title or Position:
AR ANALYST
Authorized Official Telephone Number:
813-626-1444

Provider Taxonomy Codes

  • Taxonomy code: 320900000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 631801100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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