Provider Demographics
NPI:1083828735
Name:PSI SERVICES III, INC
Entity Type:Organization
Organization Name:PSI SERVICES III, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMS & IT DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHAWN
Authorized Official - Middle Name:
Authorized Official - Last Name:RUBBIN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-552-7120
Mailing Address - Street 1:8301 PROFESSIONAL PL STE 205
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-2353
Mailing Address - Country:US
Mailing Address - Phone:301-552-7120
Mailing Address - Fax:
Practice Address - Street 1:5820 DIX ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-6965
Practice Address - Country:US
Practice Address - Phone:202-547-3870
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-05-10
Last Update Date:2020-08-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC0020261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC022659200Medicaid