Provider Demographics
NPI:1982000626
Name:CISCO CENTER FOUNDATION, INC.
Entity Type:Organization
Organization Name:CISCO CENTER FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:CISCO
Authorized Official - Middle Name:
Authorized Official - Last Name:NOCHERA
Authorized Official - Suffix:
Authorized Official - Credentials:MS ED
Authorized Official - Phone:410-647-1503
Mailing Address - Street 1:350 BALTIMORE ANNAPOLIS BLVD
Mailing Address - Street 2:
Mailing Address - City:SEVERNA PARK
Mailing Address - State:MD
Mailing Address - Zip Code:21146-1370
Mailing Address - Country:US
Mailing Address - Phone:410-647-1503
Mailing Address - Fax:
Practice Address - Street 1:350 BALTIMORE ANNAPOLIS BLVD
Practice Address - Street 2:
Practice Address - City:SEVERNA PARK
Practice Address - State:MD
Practice Address - Zip Code:21146-1370
Practice Address - Country:US
Practice Address - Phone:410-647-1503
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-11-07
Last Update Date:2014-11-07
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD161882252Y00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes252Y00000XAgenciesEarly Intervention Provider Agency
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD161882OtherCHILDCARE LICENSE