Provider Demographics
NPI:1851339808
Name:DESCANSO, INC
Entity Type:Organization
Organization Name:DESCANSO, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:YASMIN
Authorized Official - Middle Name:INDIA
Authorized Official - Last Name:LLUVERAS
Authorized Official - Suffix:
Authorized Official - Credentials:LCSW-C
Authorized Official - Phone:240-643-2728
Mailing Address - Street 1:PO BOX 1103
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20849-1103
Mailing Address - Country:US
Mailing Address - Phone:240-643-2728
Mailing Address - Fax:301-670-2254
Practice Address - Street 1:50 W MONTGOMERY AVE
Practice Address - Street 2:SUITE 110
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-4216
Practice Address - Country:US
Practice Address - Phone:240-643-2728
Practice Address - Fax:301-670-2254
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-03
Last Update Date:2008-08-11
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD407063100Medicaid
MD469CDEOtherBLUE CROSS
DCN076OtherBLUE CROSS
MDN0760001OtherBLUE CROSS
MD11517912OtherCAQH