Organization Name: | PRIME MD LLC |
NPI Number: | 1558540161 |
Entity Type Code: | Organizational (2) |
Authorized Official Name: | SUZAN KHALIL ABDO (OWNER/PHYSICIAN) |
Mailing Address: | 5005 Signal Bell Ln Suite 202 Clarksville |
State: | MD US |
Postal Code: | 210292606 |
Phone Number: | 4435358500 |
Fax Number: | 4105311446 |
NPI Enumeration Date: | 10/31/2007 |
NPI Last Update Date: | 09/16/2010 |
Replacement NPI: | 0 |
NPI Deactivation Date: | |
NPI Reactivation Date: |
Taxonomy Information: | |
Healthcare Provider Taxonomy: | 320800000X |
License Number: | D50870 |
Healthcare Provider Taxonomy: (Secondary) | N |
State: | MD |
Taxonomy Type: | Residential Treatment Facilities |
Taxonomy Classification: | Community Based Residential Treatment Facility, Mental Illness |
Taxonomy Specialization: | |
Taxonomy Definition: | A home-like residential facility providing psychiatric treatment and psycho/social rehabilitative services to individuals diagnosed with mental illness. |