Provider Demographics
NPI: | 1720402415 |
---|---|
Name: | DARMA INC |
Entity Type: | Organization |
Organization Name: | DARMA INC |
Other - Org Name: | HAROLD WILLIS CENTER |
Other - Org Type: | Doing Business As |
Authorized Official - Title/Position: | CEO |
Authorized Official - Prefix: | MS |
Authorized Official - First Name: | TINA |
Authorized Official - Middle Name: | MARIE |
Authorized Official - Last Name: | ALLEN |
Authorized Official - Suffix: | |
Authorized Official - Credentials: | MSW |
Authorized Official - Phone: | 202-679-6788 |
Mailing Address - Street 1: | 12921 DUNKIRK DR |
Mailing Address - Street 2: | |
Mailing Address - City: | UPPER MARLBORO |
Mailing Address - State: | MD |
Mailing Address - Zip Code: | 20772-9303 |
Mailing Address - Country: | US |
Mailing Address - Phone: | 202-679-6788 |
Mailing Address - Fax: | 202-800-7470 |
Practice Address - Street 1: | 12921 DUNKIRK DR |
Practice Address - Street 2: | |
Practice Address - City: | UPPER MARLBORO |
Practice Address - State: | MD |
Practice Address - Zip Code: | 20772-9303 |
Practice Address - Country: | US |
Practice Address - Phone: | 202-679-6788 |
Practice Address - Fax: | 202-800-7470 |
EIN: | <UNAVAIL> |
Is Organization Subpart?: | No |
Parent Organization LBN: | |
Parent Organization TIN: | |
Enumeration Date: | 2014-02-14 |
Last Update Date: | 2014-02-14 |
Deactivation Date: | |
Deactivation Code: | |
Reactivation Date: |
Provider Licenses
State | License ID | Taxonomies |
---|---|---|
MD | 19625 | 302F00000X |
Provider Taxonomies
Primary? | Code | Type | Classification | Specialization |
---|---|---|---|---|
Yes | 302F00000X | Managed Care Organizations | Exclusive Provider Organization |