Provider Demographics
NPI:1558668947
Name:FESCUM INC
Entity Type:Organization
Organization Name:FESCUM INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FOLORUNSO
Authorized Official - Middle Name:PAUL
Authorized Official - Last Name:IJITI
Authorized Official - Suffix:
Authorized Official - Credentials:BSC SOCILOGY, NURSE
Authorized Official - Phone:301-442-2521
Mailing Address - Street 1:6304 WILLOW WAY
Mailing Address - Street 2:
Mailing Address - City:CLINTON
Mailing Address - State:MD
Mailing Address - Zip Code:20735-3956
Mailing Address - Country:US
Mailing Address - Phone:301-877-5217
Mailing Address - Fax:
Practice Address - Street 1:6304 WILLOW WAY
Practice Address - Street 2:
Practice Address - City:CLINTON
Practice Address - State:MD
Practice Address - Zip Code:20735-3956
Practice Address - Country:US
Practice Address - Phone:301-877-5217
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-02-21
Last Update Date:2011-02-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCLP41520320600000X, 323P00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
No323P00000XResidential Treatment FacilitiesPsychiatric Residential Treatment Facility