1770976938 NPI number — MARY'S CENTER FOR MATERNAL & CHILD CARE, INC

Table of content: (NPI 1770976938)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1770976938 NPI number — MARY'S CENTER FOR MATERNAL & CHILD CARE, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
MARY'S CENTER FOR MATERNAL & CHILD CARE, 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:
MARY'S CENTER FOR MATERNAL & CHILD CARE, INC
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:
1770976938
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/05/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
2333 ONTARIO RD NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20009-2627
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-420-7175
Provider Business Mailing Address Fax Number:

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2333 ONTARIO RD NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20009-2627
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-420-7175
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
03/12/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GOMEZ
Authorized Official First Name:
MARIA
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT & CEO
Authorized Official Telephone Number:
202-420-7167

Provider Taxonomy Codes

  • Taxonomy code: 174400000X , with the licence number:  64001664 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QF0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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





Copyright © 2007-2024 www.npivalidator.com