Provider Demographics
NPI:1376326728
Name:MCCLENDON CENTER
Entity Type:Organization
Organization Name:MCCLENDON CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:COMMUNITY SUPPORT SPECIALIST
Authorized Official - Prefix:
Authorized Official - First Name:ADEBUSOLA
Authorized Official - Middle Name:BOSE
Authorized Official - Last Name:ODUBENA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-716-8673
Mailing Address - Street 1:1313 NEW YORK AVE NW FL 5
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-4701
Mailing Address - Country:US
Mailing Address - Phone:240-716-8673
Mailing Address - Fax:
Practice Address - Street 1:1338 N CAPITOL ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-3396
Practice Address - Country:US
Practice Address - Phone:240-716-8673
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2023-08-17
Last Update Date:2023-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251B00000XAgenciesCase Management