1881960912 NPI number — IVYMOUNT OUTREACH PROGRAMS, INC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881960912 NPI number — IVYMOUNT OUTREACH PROGRAMS, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
IVYMOUNT OUTREACH PROGRAMS, 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:
Provider Other Organization Name Type Code:
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:
1881960912
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/22/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
11614 SEVEN LOCKS RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20854-3261
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-469-0223
Provider Business Mailing Address Fax Number:
301-469-0778

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
11614 SEVEN LOCKS RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20854-3261
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-469-0223
Provider Business Practice Location Address Fax Number:
301-469-0778
Provider Enumeration Date:
03/22/2012

Additional Information

Authorized Official

Authorized Official Last Name:
OPPENHEIM
Authorized Official First Name:
LEE-NADINE
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF FINANCE/ADMINISTRATION
Authorized Official Telephone Number:
301-469-0223

Provider Taxonomy Codes

  • Taxonomy code: 251S00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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