Provider Demographics
NPI:1114642782
Name:ABREAST THERAPEUTIC CENTER INC
Entity Type:Organization
Organization Name:ABREAST THERAPEUTIC CENTER INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:ABAYOMI
Authorized Official - Middle Name:
Authorized Official - Last Name:SOKOYA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-764-5180
Mailing Address - Street 1:9418 ANNAPOLIS RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-3053
Mailing Address - Country:US
Mailing Address - Phone:240-764-5180
Mailing Address - Fax:240-467-3981
Practice Address - Street 1:9418 ANNAPOLIS RD STE 202
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3053
Practice Address - Country:US
Practice Address - Phone:240-764-5180
Practice Address - Fax:240-467-3981
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-10-06
Last Update Date:2023-02-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD888175800Medicaid