Provider Demographics
NPI:1093750697
Name:FAMILY HEALTH CENTER
Entity Type:Organization
Organization Name:FAMILY HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:DR
Authorized Official - First Name:BRUKE
Authorized Official - Middle Name:
Authorized Official - Last Name:TADESSE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-779-2461
Mailing Address - Street 1:6 MONTGOMERY VILLAGE AVE
Mailing Address - Street 2:400
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3546
Mailing Address - Country:US
Mailing Address - Phone:301-963-7222
Mailing Address - Fax:301-963-2616
Practice Address - Street 1:6 MONTGOMERY VILLAGE AVE
Practice Address - Street 2:400
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20879-3546
Practice Address - Country:US
Practice Address - Phone:301-963-7222
Practice Address - Fax:301-963-2616
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-18
Last Update Date:2020-12-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
101YM0800X, 103TA0400X, 261QM0850X
MDLC0295103TP2701X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes103TP2701XBehavioral Health & Social Service ProvidersPsychologistGroup PsychotherapyGroup - Multi-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No103TA0400XBehavioral Health & Social Service ProvidersPsychologistAddiction (Substance Use Disorder)Group - Multi-Specialty
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental HealthGroup - Multi-Specialty