Provider Demographics
NPI:1417416694
Name:COMMUNITY THERAPEUTIC CENTER,INC
Entity Type:Organization
Organization Name:COMMUNITY THERAPEUTIC CENTER,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:O
Authorized Official - Last Name:OWOOJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-764-5133
Mailing Address - Street 1:4325 FORBES BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4853
Mailing Address - Country:US
Mailing Address - Phone:240-764-5133
Mailing Address - Fax:
Practice Address - Street 1:4325 FORBES BLVD STE A
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4853
Practice Address - Country:US
Practice Address - Phone:240-764-5133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:OUT PATIENT MENTAL HEALTH CLINIC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2019-03-18
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
No261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
No261QM0855XAmbulatory Health Care FacilitiesClinic/CenterAdolescent and Children Mental Health
No261QM2500XAmbulatory Health Care FacilitiesClinic/CenterMedical Specialty
No385HR2060XRespite Care FacilityRespite CareRespite Care, Intellectual and/or Developmental Disabilities, Child
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1900222600Medicaid