Provider Demographics
NPI:1174110266
Name:FAMILY HEALTH CENTER INC.
Entity type:Organization
Organization Name:FAMILY HEALTH CENTER INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OFFICE MANAGER/COUNSELOR
Authorized Official - Prefix:
Authorized Official - First Name:ALVARO
Authorized Official - Middle Name:WILFRIDO
Authorized Official - Last Name:JAYA
Authorized Official - Suffix:
Authorized Official - Credentials:CSC-AD
Authorized Official - Phone:301-963-7222
Mailing Address - Street 1:6 MONTGOMERY VILLAGE AVE STE 400
Mailing Address - Street 2:
Mailing Address - City:GAITHERSBURG
Mailing Address - State:MD
Mailing Address - Zip Code:20879-3548
Mailing Address - Country:US
Mailing Address - Phone:301-963-7222
Mailing Address - Fax:301-963-2616
Practice Address - Street 1:3415 HAMILTON ST STE 9
Practice Address - Street 2:
Practice Address - City:W HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20782-3953
Practice Address - Country:US
Practice Address - Phone:301-779-2461
Practice Address - Fax:301-779-6095
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2020-12-23
Last Update Date:2020-12-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD1316126121OtherNPI