Provider Demographics
NPI:1669231346
Name:SACRED MOUNTAINS LIMITED LIABILITY COMPANY
Entity type:Organization
Organization Name:SACRED MOUNTAINS LIMITED LIABILITY COMPANY
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MR
Authorized Official - First Name:AGUSTIN
Authorized Official - Middle Name:ALFONSO
Authorized Official - Last Name:AGUIRRE HERRERA
Authorized Official - Suffix:
Authorized Official - Credentials:MSW
Authorized Official - Phone:202-810-1624
Mailing Address - Street 1:5503 43RD AVE
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20781-1906
Mailing Address - Country:US
Mailing Address - Phone:202-810-1624
Mailing Address - Fax:
Practice Address - Street 1:5503 43RD AVE
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20781-1906
Practice Address - Country:US
Practice Address - Phone:202-810-1624
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-03-15
Last Update Date:2024-03-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty