1093039182 NPI number — FAMILY SERVICE FOUNDATION, INC

Table of content: (NPI 1093039182)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1093039182 NPI number — FAMILY SERVICE FOUNDATION, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
FAMILY SERVICE FOUNDATION, 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:
6
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:
1093039182
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/19/2012
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
5301 76TH AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
LANDOVER HILLS
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20784-1703
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-459-2121
Provider Business Mailing Address Fax Number:
301-918-9757

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
306 DELAWARE ROAD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FREDERICK
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21701-4618
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-378-0261
Provider Business Practice Location Address Fax Number:
301-378-0267
Provider Enumeration Date:
03/18/2010

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
DAPHNE
Authorized Official Middle Name:
Authorized Official Title or Position:
BILLING MANAGER
Authorized Official Telephone Number:
301-459-2121

Provider Taxonomy Codes

  • Taxonomy code: 103TR0400X , with the licence number:  4163 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 320741200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2025 www.npivalidator.com