Organization
PHASE LL ACADEMY
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MS. SHERRY DEAN FENNER (PROGRAM DIRECTOR)
(202) 544-0261
Entity
Organization
Contact information
Practice address
501 E ST SE, WASHINGTON, DC 20003-4236
(202) 544-0261
(202) 544-0262
Mailing address
3601 HAMILTON ST, SUITE 204, HYATTSVILLE, MD 20782-3946
(202) 544-0261
(202) 544-0262
Taxonomy
Speciality
Code
Description
License number
State
174400000X
Specialist
Primary
—
—
Other
Enumeration date
05/18/2007
Last updated
08/22/2020
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