Organization
ACT IV
Active
Other names
Community Services Agency
Organization subpart
No
Provider details
NPI number
Authorized official
MR. TYRONE FIZER (VOCATIONAL SPECIALIST)
(202) 645-7256
Entity
Organization
Contact information
Practice address
10951 POPLAR RIDGE ROAD, BRANDYWINE, MD 20613
(301) 579-2482
Mailing address
19051 POPLAR RIDGE RD, BRANDYWINE, MD 20613-3910
(301) 579-2482
Taxonomy
Speciality
Code
Description
License number
State
251B00000X
Case Management Agency
Primary
F206809018964
MD
Other
Enumeration date
03/16/2007
Last updated
06/16/2008
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