Basic Information
| Provider Information | |||||||||
| NPI: | 1861697823 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SPANISH CATHOLIC CHARITIES CATHOLIC COMMUNITY SERVICES | ||||||||
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| Mailing Information | |||||||||
| Address1: | 12247 GEORGIA AVE | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209025523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014348385 | ||||||||
| FaxNumber: | 3014348067 | ||||||||
| Practice Location | |||||||||
| Address1: | 12247 GEORGIA AVE | ||||||||
| Address2: | |||||||||
| City: | SILVER SPRING | ||||||||
| State: | MD | ||||||||
| PostalCode: | 209025523 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3014348385 | ||||||||
| FaxNumber: | 3014348067 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 06/19/2007 | ||||||||
| LastUpdateDate: | 05/13/2019 | ||||||||
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| AuthorizedOfficialLastName: | IZQUIERDO | ||||||||
| AuthorizedOfficialFirstName: | ANNA | ||||||||
| AuthorizedOfficialMiddleName: | MARIA | ||||||||
| AuthorizedOfficialTitleorPosition: | DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 2029392412 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialCredential: | M.D. | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QC1500X | R096580 | MD | N | Ambulatory Health Care Facilities | Clinic/Center | Community Health | 1041C0700X | Y | 193400000X SINGLE SPECIALTY GROUP | Behavioral Health & Social Service Providers | Social Worker | Clinical |
No ID Information.