Provider Demographics
NPI:1568595171
Name:INTEGRATED BEHAVIOR SERVICES GROUP INC
Entity Type:Organization
Organization Name:INTEGRATED BEHAVIOR SERVICES GROUP INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:MARY
Authorized Official - Middle Name:J
Authorized Official - Last Name:SAMBA
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-610-0144
Mailing Address - Street 1:3200 S ST SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-2410
Mailing Address - Country:US
Mailing Address - Phone:202-610-1444
Mailing Address - Fax:202-610-1445
Practice Address - Street 1:3200 S ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020
Practice Address - Country:US
Practice Address - Phone:202-610-1444
Practice Address - Fax:202-610-1445
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-03-13
Last Update Date:2018-07-10
Deactivation Date:2007-07-17
Deactivation Code:
Reactivation Date:2007-07-26
Provider Licenses
StateLicense IDTaxonomies
DC036003900261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036003900Medicaid