Provider Demographics
NPI:1649416637
Name:PRINCE GEORGE'S COUNTY INFANTS & TODDLERS PROGRAM
Entity Type:Organization
Organization Name:PRINCE GEORGE'S COUNTY INFANTS & TODDLERS PROGRAM
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PROGRAM DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:SHARON
Authorized Official - Middle Name:LYNN
Authorized Official - Last Name:LEYDEN
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-856-9465
Mailing Address - Street 1:9201 BASIL CT
Mailing Address - Street 2:SUITE 440
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5343
Mailing Address - Country:US
Mailing Address - Phone:301-856-9465
Mailing Address - Fax:301-856-6459
Practice Address - Street 1:9201 BASIL CT
Practice Address - Street 2:SUITE 440
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5343
Practice Address - Country:US
Practice Address - Phone:301-856-9465
Practice Address - Fax:301-856-6459
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-12-23
Last Update Date:2008-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD410773000Medicare UPIN