Provider Demographics
NPI:1992164966
Name:MARY'S CENTER FOR MATERNAL AND CHILD CARE, INC
Entity type:Organization
Organization Name:MARY'S CENTER FOR MATERNAL AND CHILD CARE, INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:MARIA
Authorized Official - Middle Name:
Authorized Official - Last Name:GOMEZ
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-420-7005
Mailing Address - Street 1:2333 ONTARIO RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-2627
Mailing Address - Country:US
Mailing Address - Phone:202-420-7175
Mailing Address - Fax:
Practice Address - Street 1:100 GALLATIN ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011-7517
Practice Address - Country:US
Practice Address - Phone:202-483-8196
Practice Address - Fax:202-420-7164
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:MARY'S CENTER FOR MATERNAL AND CHILD CARE, INC
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-02-18
Last Update Date:2017-01-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC64001664261QD0000X
261QF0400X, 261QM0801X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
No261QD0000XAmbulatory Health Care FacilitiesClinic/CenterDental
No261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)