Provider Demographics
NPI:1790142115
Name:OURSPACE WORLD, INC.
Entity Type:Organization
Organization Name:OURSPACE WORLD, INC.
Other - Org Name:OURSPACE ACUPUNCTURE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:FARRIS
Authorized Official - Middle Name:THOMAS
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:III
Authorized Official - Credentials:LAC
Authorized Official - Phone:301-388-8085
Mailing Address - Street 1:914 SILVER SPRING AVE
Mailing Address - Street 2:SUITE 104
Mailing Address - City:SILVER SPRING
Mailing Address - State:MD
Mailing Address - Zip Code:20910-4621
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:914 SILVER SPRING AVE
Practice Address - Street 2:SUITE 104
Practice Address - City:SILVER SPRING
Practice Address - State:MD
Practice Address - Zip Code:20910-4621
Practice Address - Country:US
Practice Address - Phone:301-388-8085
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2016-01-16
Last Update Date:2016-01-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QC1500XAmbulatory Health Care FacilitiesClinic/CenterCommunity Health