Provider Demographics
NPI:1699360628
Name:UTOPIAN INSTITUTE OF FAMILY LIVING LLC
Entity Type:Organization
Organization Name:UTOPIAN INSTITUTE OF FAMILY LIVING LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TENNILLE
Authorized Official - Middle Name:
Authorized Official - Last Name:HARRIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:877-290-0201
Mailing Address - Street 1:4400 STAMP RD STE 415
Mailing Address - Street 2:
Mailing Address - City:TEMPLE HILLS
Mailing Address - State:MD
Mailing Address - Zip Code:20748-6730
Mailing Address - Country:US
Mailing Address - Phone:240-838-3094
Mailing Address - Fax:240-838-3253
Practice Address - Street 1:4400 STAMP RD STE 415
Practice Address - Street 2:
Practice Address - City:TEMPLE HILLS
Practice Address - State:MD
Practice Address - Zip Code:20748-6730
Practice Address - Country:US
Practice Address - Phone:240-838-3094
Practice Address - Fax:240-838-3253
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-03-02
Last Update Date:2021-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty