Provider Demographics
NPI:1578816997
Name:MARY'S CENTER FOR MATERNAL AND CHILD CARE, INC.
Entity Type:Organization
Organization Name:MARY'S CENTER FOR MATERNAL AND CHILD CARE, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:HR
Authorized Official - Prefix:
Authorized Official - First Name:CAROLINA
Authorized Official - Middle Name:
Authorized Official - Last Name:CARVAJAL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-420-7141
Mailing Address - Street 1:2333 ONTARIO RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2627
Mailing Address - Country:US
Mailing Address - Phone:202-483-8196
Mailing Address - Fax:
Practice Address - Street 1:2333 ONTARIO RD NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009-2627
Practice Address - Country:US
Practice Address - Phone:202-483-8196
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2013-02-01
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD039315100Medicaid
DC037536500Medicaid
DC037564900Medicaid
MD411949500Medicaid
MD411949500Medicaid
MD211890Medicare Oscar/Certification
DC091818Medicare Oscar/Certification
DC091817Medicare Oscar/Certification
DC091838Medicare Oscar/Certification
DC037564900Medicaid
MD211888Medicare Oscar/Certification
DC091839Medicare Oscar/Certification