Basic Information
| Provider Information | |||||||||
| NPI: | 1811403264 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | MARY'S CENTER FOR MATERNAL AND CHILD CARE, INC- SMART | ||||||||
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| Mailing Information | |||||||||
| Address1: | 8910 RIGGS RD | ||||||||
| Address2: | |||||||||
| City: | ADELPHI | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207831632 | ||||||||
| CountryCode: | US | ||||||||
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| Address1: | 8910 RIGGS RD | ||||||||
| Address2: | |||||||||
| City: | ADELPHI | ||||||||
| State: | MD | ||||||||
| PostalCode: | 207831632 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024838196 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 12/21/2017 | ||||||||
| LastUpdateDate: | 12/21/2017 | ||||||||
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| AuthorizedOfficialLastName: | NAZARIO | ||||||||
| AuthorizedOfficialFirstName: | MARANGELY | ||||||||
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| AuthorizedOfficialTitleorPosition: | CREDENTIALING MANAGER | ||||||||
| AuthorizedOfficialTelephone: | 2024207175 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | Y | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) |
No ID Information.