Organization Name: | KIMBROUGH AMBULATORY CARE CENTER |
NPI Number: | 1265596951 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | NAHIDA HADEESH (CLINICAL SOCIAL WORKER) |
Mailing Address: | 2480 Llewellyn Ave Fort Meade |
State: | MD US |
Postal Code: | 207555800 |
Phone Number: | 3016778586 |
Fax Number: | |
NPI Enumeration Date: | 12/20/2006 |
NPI Last Update Date: | 07/08/2007 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 261QM0801X |
License Number: | LC302917 |
Healthcare Provider Taxonomy: (Secondary) | Y |
State: | DC |
Taxonomy Type: | Ambulatory Health Care Facilities |
Taxonomy Classification: | Clinic/Center |
Taxonomy Specialization: | Mental Health (Including Community Mental Health Center) |
Taxonomy Definition: |