Provider Demographics
NPI:1265954226
Name:COMMUNITY THERAPEUTIC CENTER,INC
Entity type:Organization
Organization Name:COMMUNITY THERAPEUTIC CENTER,INC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:EMMANUEL
Authorized Official - Middle Name:OLUFEMI
Authorized Official - Last Name:OWOOJE
Authorized Official - Suffix:
Authorized Official - Credentials:NURSE
Authorized Official - Phone:240-764-5133
Mailing Address - Street 1:8181 PROFESSIONAL PL STE 213
Mailing Address - Street 2:
Mailing Address - City:HYATTSVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20785-7232
Mailing Address - Country:US
Mailing Address - Phone:240-764-5133
Mailing Address - Fax:240-764-7477
Practice Address - Street 1:8181 PROFESSIONAL PL STE 213
Practice Address - Street 2:
Practice Address - City:HYATTSVILLE
Practice Address - State:MD
Practice Address - Zip Code:20785-7232
Practice Address - Country:US
Practice Address - Phone:240-764-5133
Practice Address - Fax:240-764-7477
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:COMMUNITY THERAPEUTIC CENTER
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2017-07-12
Last Update Date:2025-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MD251S00000X, 251S00000X
261QM0850X, 261QM0850X, 251S00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health
Yes261QM0850XAmbulatory Health Care FacilitiesClinic/CenterAdult Mental Health
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD411385300Medicaid