Provider Demographics
NPI:1811001563
Name:MENDELIS MENTAL HEALTH CENTER
Entity Type:Organization
Organization Name:MENDELIS MENTAL HEALTH CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:DR
Authorized Official - First Name:PETER
Authorized Official - Middle Name:
Authorized Official - Last Name:MENDELIS
Authorized Official - Suffix:
Authorized Official - Credentials:MD
Authorized Official - Phone:301-638-5001
Mailing Address - Street 1:11315 PEMBROOKE SQUARE MEDICAL CENTER
Mailing Address - Street 2:SUITE 112
Mailing Address - City:WALDORF
Mailing Address - State:MD
Mailing Address - Zip Code:20603
Mailing Address - Country:US
Mailing Address - Phone:301-638-5001
Mailing Address - Fax:301-638-5003
Practice Address - Street 1:11315 PEMBROOKE SQUARE MEDICAL CENTER
Practice Address - Street 2:SUITE 112
Practice Address - City:WALDORF
Practice Address - State:MD
Practice Address - Zip Code:20603
Practice Address - Country:US
Practice Address - Phone:301-638-5001
Practice Address - Fax:301-638-5003
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-19
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)