Provider Demographics
NPI:1891822557
Name:FAMILY PRESERVATION SERVICES OF DC
Entity Type:Organization
Organization Name:FAMILY PRESERVATION SERVICES OF DC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MID-ATLANTIC DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:RICK
Authorized Official - Middle Name:
Authorized Official - Last Name:SMITH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-543-0387
Mailing Address - Street 1:10304 SPOTSYLVANIA AVE
Mailing Address - Street 2:STE 300
Mailing Address - City:FREDERICKSBURG
Mailing Address - State:VA
Mailing Address - Zip Code:22408-8602
Mailing Address - Country:US
Mailing Address - Phone:540-710-6085
Mailing Address - Fax:540-710-6447
Practice Address - Street 1:810 POTOMAC AVE SE
Practice Address - Street 2:STE 107
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-3600
Practice Address - Country:US
Practice Address - Phone:202-543-0387
Practice Address - Fax:202-543-2758
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-02-28
Last Update Date:2009-06-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC036524800Medicaid