Provider Demographics
NPI:1124365325
Name:POTOMAC LIGHTHOUSE PCS
Entity Type:Organization
Organization Name:POTOMAC LIGHTHOUSE PCS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRINCIPAL
Authorized Official - Prefix:
Authorized Official - First Name:RAMON
Authorized Official - Middle Name:
Authorized Official - Last Name:RICHARDSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-526-6003
Mailing Address - Street 1:4401 8TH ST NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20017-2200
Mailing Address - Country:US
Mailing Address - Phone:202-526-6003
Mailing Address - Fax:202-526-6005
Practice Address - Street 1:4401 8TH ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20017-2200
Practice Address - Country:US
Practice Address - Phone:202-526-6003
Practice Address - Fax:202-526-6005
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-01-08
Last Update Date:2013-01-08
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251300000XAgenciesLocal Education Agency (LEA)