Provider Demographics
NPI:1568761526
Name:POOL OF BETHESDA COMMUNITY SERVICES, INC.
Entity Type:Organization
Organization Name:POOL OF BETHESDA COMMUNITY SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MRS
Authorized Official - First Name:SUSAN
Authorized Official - Middle Name:N
Authorized Official - Last Name:KONNEH
Authorized Official - Suffix:
Authorized Official - Credentials:RN
Authorized Official - Phone:301-220-0628
Mailing Address - Street 1:5020 SUNNYSIDE AVE STE 104
Mailing Address - Street 2:
Mailing Address - City:BELTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20705-2307
Mailing Address - Country:US
Mailing Address - Phone:301-220-0628
Mailing Address - Fax:301-220-0629
Practice Address - Street 1:5020 SUNNYSIDE AVE STE 104
Practice Address - Street 2:
Practice Address - City:BELTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20705-2307
Practice Address - Country:US
Practice Address - Phone:301-220-0628
Practice Address - Fax:301-220-0629
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:FAWEMA ENTERPRISES, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2011-03-16
Last Update Date:2011-03-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes315P00000XNursing & Custodial Care FacilitiesIntermediate Care Facility, Intellectual Disabilities