Provider Demographics
NPI:1982809760
Name:FAMILY TRAUMA SERVICES, INC.
Entity Type:Organization
Organization Name:FAMILY TRAUMA SERVICES, INC.
Other - Org Name:FAMILY TRAUMA SERVICES OF MARYLAND, INC.
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:WAYNE
Authorized Official - Middle Name:D
Authorized Official - Last Name:PARKS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-306-6306
Mailing Address - Street 1:PO BOX 2065
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20847-2065
Mailing Address - Country:US
Mailing Address - Phone:301-306-6306
Mailing Address - Fax:301-306-6306
Practice Address - Street 1:9470 ANNAPOLIS RD
Practice Address - Street 2:SUITE 209
Practice Address - City:LANHAM
Practice Address - State:MD
Practice Address - Zip Code:20706-3025
Practice Address - Country:US
Practice Address - Phone:301-306-6306
Practice Address - Fax:301-306-6304
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-20
Last Update Date:2008-06-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD521170101Medicaid