Basic Information
Provider Information | |||||||||
NPI: | 1255875753 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | CONTEMPORARY FAMILY SERVICES, INC | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: |   | ||||||||
OtherOrganizationType: |   | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 6525 BELCREST RD | ||||||||
Address2: | SUITE G40 | ||||||||
City: | HYATTSVILLE | ||||||||
State: | MD | ||||||||
PostalCode: | 207822003 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2403751957 | ||||||||
FaxNumber: |   | ||||||||
Practice Location | |||||||||
Address1: | 6525 BELCREST RD. | ||||||||
Address2: | G40 | ||||||||
City: | HYATTSVILLE | ||||||||
State: | MD | ||||||||
PostalCode: | 207822003 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2403751957 | ||||||||
FaxNumber: | 3017790258 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 12/19/2016 | ||||||||
LastUpdateDate: | 12/19/2016 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | MONROE | ||||||||
AuthorizedOfficialFirstName: | JOHN | ||||||||
AuthorizedOfficialMiddleName: | LEWIS | ||||||||
AuthorizedOfficialTitleorPosition: | CEO | ||||||||
AuthorizedOfficialTelephone: | 2403751957 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | DR. | ||||||||
AuthorizedOfficialNameSuffix: | JR. | ||||||||
AuthorizedOfficialCredential: | DSW | ||||||||
NPICertificationDate: |   |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 3245S0500X |   |   | N |   | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility | Substance Abuse Treatment, Children | 324500000X |   |   | Y |   | Residential Treatment Facilities | Substance Abuse Rehabilitation Facility |   |
No ID Information.