Provider Demographics
NPI:1659350767
Name:ACCOKEEK COMMUNITY DEVELOPMENT CORP
Entity Type:Organization
Organization Name:ACCOKEEK COMMUNITY DEVELOPMENT CORP
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:TONI
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-932-8659
Mailing Address - Street 1:3070 CRAIN HWY
Mailing Address - Street 2:SUITE 102
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20601-2830
Mailing Address - Country:US
Mailing Address - Phone:301-932-8659
Mailing Address - Fax:301-932-7202
Practice Address - Street 1:3070 CRAIN HWY
Practice Address - Street 2:SUITE 102
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20601-2830
Practice Address - Country:US
Practice Address - Phone:301-932-8659
Practice Address - Fax:301-932-7202
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-01-17
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health