Provider Demographics
NPI:1821341249
Name:MARY'S CENTER FOR MATERNAL & CHILD CARE
Entity Type:Organization
Organization Name:MARY'S CENTER FOR MATERNAL & CHILD CARE
Other - Org Name:MARY'S CENTER FOR MATERNAL AND CHILD CARE, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CREDENTIALING MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:MARANGELY
Authorized Official - Middle Name:
Authorized Official - Last Name:NAZARIO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-420-7175
Mailing Address - Street 1:2333 ONTARIO RD. NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009
Mailing Address - Country:US
Mailing Address - Phone:202-483-8196
Mailing Address - Fax:202-545-2069
Practice Address - Street 1:3912 GEORGIA AVE. NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-5861
Practice Address - Country:US
Practice Address - Phone:202-483-8196
Practice Address - Fax:202-545-2070
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-10-23
Last Update Date:2020-09-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
251B00000X, 261QF0400X
DC64001664261QD0000X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No251B00000XAgenciesCase Management
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037564900Medicaid
MD039315100Medicaid
DC037536500Medicaid
MD411949500Medicaid
MD039315100Medicaid
DC037564900Medicaid
DC091818Medicare Oscar/Certification
DCG01263Medicare Oscar/Certification
MD411949500Medicaid
DC037536500Medicaid
MD211888Medicare Oscar/Certification
DC091839Medicare Oscar/Certification