Provider Demographics
NPI:1023356847
Name:FAMILY SERVICES, INC/THE SUPPORT CENTER
Entity Type:Organization
Organization Name:FAMILY SERVICES, INC/THE SUPPORT CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:PAULETTE
Authorized Official - Middle Name:JACQUELINE
Authorized Official - Last Name:CRADDOCK
Authorized Official - Suffix:
Authorized Official - Credentials:RN BSN
Authorized Official - Phone:301-738-2250
Mailing Address - Street 1:1010 GRANDIN AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-1300
Mailing Address - Country:US
Mailing Address - Phone:301-738-2250
Mailing Address - Fax:
Practice Address - Street 1:1010 GRANDIN AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20851-1300
Practice Address - Country:US
Practice Address - Phone:301-738-2250
Practice Address - Fax:301-309-1797
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAMILY SERVICES, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2013-01-29
Last Update Date:2013-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD15 007 C261QA0600X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care