Provider Demographics
NPI:1255063020
Name:PRINCE GEORGE'S CHILD RESOURCE CENTER, INC.
Entity type:Organization
Organization Name:PRINCE GEORGE'S CHILD RESOURCE CENTER, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:JENNIFER
Authorized Official - Middle Name:
Authorized Official - Last Name:IVERSON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-772-8420
Mailing Address - Street 1:9475 LOTTSFORD RD STE 202
Mailing Address - Street 2:
Mailing Address - City:LARGO
Mailing Address - State:MD
Mailing Address - Zip Code:20774-5308
Mailing Address - Country:US
Mailing Address - Phone:301-772-8420
Mailing Address - Fax:301-772-8410
Practice Address - Street 1:9475 LOTTSFORD RD STE 202
Practice Address - Street 2:
Practice Address - City:LARGO
Practice Address - State:MD
Practice Address - Zip Code:20774-5308
Practice Address - Country:US
Practice Address - Phone:301-772-8420
Practice Address - Fax:301-772-8410
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2022-06-29
Last Update Date:2022-06-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes174H00000XOther Service ProvidersHealth EducatorGroup - Single Specialty