Provider Demographics
NPI:1336181775
Name:HEAD INJURY REHABILITATION AND REFERRAL SERVICES, INC.
Entity Type:Organization
Organization Name:HEAD INJURY REHABILITATION AND REFERRAL SERVICES, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:
Authorized Official - First Name:RICARDO
Authorized Official - Middle Name:
Authorized Official - Last Name:HUNTER
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-309-2228
Mailing Address - Street 1:11 TAFT CT STE 100
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-5350
Mailing Address - Country:US
Mailing Address - Phone:301-309-2228
Mailing Address - Fax:301-309-2278
Practice Address - Street 1:11 TAFT CT STE 100
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5350
Practice Address - Country:US
Practice Address - Phone:301-309-2228
Practice Address - Fax:301-309-2278
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-11
Last Update Date:2018-04-10
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MDDDA3795-98251C00000X
MDDDA-29155251C00000X, 320900000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities
No251C00000XAgenciesDay Training, Developmentally Disabled Services
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD209610200Medicaid
MD228850800Medicaid