Provider Demographics
NPI:1063894699
Name:ISPAR FOUNDATION, INC.
Entity type:Organization
Organization Name:ISPAR FOUNDATION, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:VIKTORIYA
Authorized Official - Middle Name:
Authorized Official - Last Name:KARAKCHEYEVA
Authorized Official - Suffix:
Authorized Official - Credentials:LCPC
Authorized Official - Phone:240-997-1964
Mailing Address - Street 1:5914 VANDEGRIFT AVE
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20851-1940
Mailing Address - Country:US
Mailing Address - Phone:240-997-1964
Mailing Address - Fax:
Practice Address - Street 1:5914 VANDEGRIFT AVE
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20851-1940
Practice Address - Country:US
Practice Address - Phone:240-997-1964
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2015-06-19
Last Update Date:2015-06-19
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes320800000XResidential Treatment FacilitiesCommunity Based Residential Treatment Facility, Mental Illness