Organization
ANEW INSPIRED CHANGE ORGANIZATION
Active
Organization subpart
No
Provider details
NPI number
Authorized official
PORSHIA EVERETT (DIRECTOR)
(301) 971-2639
Entity
Organization
Contact information
Practice address
1400 MERCANTILE LN STE 246, UPPER MARLBORO, MD 20774-5353
(301) 971-2639
(301) 386-5262
Mailing address
1400 MERCANTILE LN STE 246, UPPER MARLBORO, MD 20774-5353
(301) 971-2639
(301) 386-5262
Taxonomy
Speciality
Code
Description
License number
State
310400000X
Assisted Living Facility
Primary
—
MD
3104A0625X
Assisted Living Facility (Mental Illness)
—
MD
3104A0630X
Assisted Living Facility (Behavioral Disturbances)
—
MD
Other
Enumeration date
04/26/2018
Last updated
06/16/2018
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