Provider Demographics
NPI:1629677059
Name:ARISE AND SHINE SUPPORT SERVICES INC
Entity Type:Organization
Organization Name:ARISE AND SHINE SUPPORT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JEAN PIERRE D
Authorized Official - Middle Name:
Authorized Official - Last Name:MONDO MBONGO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-466-1476
Mailing Address - Street 1:8101 RED FARM LN
Mailing Address - Street 2:
Mailing Address - City:BOWIE
Mailing Address - State:MD
Mailing Address - Zip Code:20715-3385
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:1506 21ST ST NW STE 100
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20036-1017
Practice Address - Country:US
Practice Address - Phone:443-466-1476
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-10-16
Last Update Date:2020-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
No251B00000XAgenciesCase Management