Organization
FESCUM INC
Active
Organization subpart
No
Provider details
NPI number
Authorized official
MR. FOLORUNSO PAUL IJITI BSC SOCILOGY, NURSE (DIRECTOR)
(301) 442-2521
Entity
Organization
Contact information
Practice address
6304 WILLOW WAY, CLINTON, MD 20735-3956
(301) 877-5217
Mailing address
6304 WILLOW WAY, CLINTON, MD 20735-3956
(301) 877-5217
Taxonomy
Speciality
Code
Description
License number
State
320600000X
Intellectual and/or Developmental Disabilities Residential Treatment Facility
Primary
LP41520
DC
323P00000X
Psychiatric Residential Treatment Facility
LP41520
DC
Other
Enumeration date
02/21/2011
Last updated
02/21/2011
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