Provider Demographics
NPI:1699931733
Name:ROBERTA'S DEVELOPMENTAL DISABILITY CTR.
Entity type:Organization
Organization Name:ROBERTA'S DEVELOPMENTAL DISABILITY CTR.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER
Authorized Official - Prefix:MS
Authorized Official - First Name:ROBERTA
Authorized Official - Middle Name:
Authorized Official - Last Name:MUMFORD
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-233-1314
Mailing Address - Street 1:PO BOX 993
Mailing Address - Street 2:
Mailing Address - City:OXON HILL
Mailing Address - State:MD
Mailing Address - Zip Code:20750-0993
Mailing Address - Country:US
Mailing Address - Phone:
Mailing Address - Fax:
Practice Address - Street 1:2012 HIGH TIMBER RD
Practice Address - Street 2:
Practice Address - City:FT WASHINGTON
Practice Address - State:MD
Practice Address - Zip Code:20744-3125
Practice Address - Country:US
Practice Address - Phone:301-233-1314
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-07-29
Last Update Date:2008-07-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes385H00000XRespite Care FacilityRespite Care