Provider Demographics
NPI:1063087930
Name:DEVELOPMENTAL SUPPORTS CENTER
Entity type:Organization
Organization Name:DEVELOPMENTAL SUPPORTS CENTER
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:OLUSEGUN
Authorized Official - Middle Name:
Authorized Official - Last Name:SOFOWOTE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:443-527-9261
Mailing Address - Street 1:7105 RUDISILL CT APT 1A
Mailing Address - Street 2:
Mailing Address - City:WINDSOR MILL
Mailing Address - State:MD
Mailing Address - Zip Code:21244-6533
Mailing Address - Country:US
Mailing Address - Phone:443-527-9261
Mailing Address - Fax:
Practice Address - Street 1:7105 RUDISILL CT APT 1A
Practice Address - Street 2:
Practice Address - City:WINDSOR MILL
Practice Address - State:MD
Practice Address - Zip Code:21244-6533
Practice Address - Country:US
Practice Address - Phone:443-527-9261
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2021-05-24
Last Update Date:2021-07-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320900000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities