Provider Demographics
NPI:1639245830
Name:CHILD CENTER AND ADULT SERVICES INC
Entity Type:Organization
Organization Name:CHILD CENTER AND ADULT SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CO DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:NANCY
Authorized Official - Middle Name:E
Authorized Official - Last Name:EBB
Authorized Official - Suffix:
Authorized Official - Credentials:LCSWC JD
Authorized Official - Phone:301-978-9750
Mailing Address - Street 1:16220 S FREDERICK AVENUE
Mailing Address - Street 2:SUITE 502
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20877-4022
Mailing Address - Country:US
Mailing Address - Phone:301-978-9750
Mailing Address - Fax:301-978-9753
Practice Address - Street 1:16220 S FREDERICK AVENUE
Practice Address - Street 2:SUITE 502
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-4022
Practice Address - Country:US
Practice Address - Phone:301-978-9750
Practice Address - Fax:301-978-9753
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2012-07-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD063210400Medicaid
DC669854Medicare ID - Type Unspecified