Provider Demographics
NPI:1922641307
Name:COMMUNITY THERAPEUTIC CENTER,INC
Entity Type:Organization
Organization Name:COMMUNITY THERAPEUTIC CENTER,INC
Other - Org Name:COMMUNITY THERAPEUTIC CENTER,INC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:
Authorized Official - Last Name:OWOOJE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:240-764-5133
Mailing Address - Street 1:4325 FORBES BLVD STE A
Mailing Address - Street 2:
Mailing Address - City:LANHAM
Mailing Address - State:MD
Mailing Address - Zip Code:20706-4853
Mailing Address - Country:US
Mailing Address - Phone:240-764-5133
Mailing Address - Fax:
Practice Address - Street 1:4325 FORBES BLVD STE A
Practice Address - Street 2:
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-4853
Practice Address - Country:US
Practice Address - Phone:240-764-5133
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2019-10-18
Last Update Date:2021-05-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM1300XAmbulatory Health Care FacilitiesClinic/CenterMulti-Specialty
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Multi-Specialty
No251S00000XAgenciesCommunity/Behavioral Health
No261QA0600XAmbulatory Health Care FacilitiesClinic/CenterAdult Day CareGroup - Multi-Specialty
No261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1900222600Medicaid