Organization
FEDSERVE
Active
Organization
FEDSERVE
Active
Organization subpart
No
Provider details
NPI number
Authorized official
DANIEL ODUKOYA (MANAGING DIRECTOR)
(301) 841-5077
Entity
Organization
Contact information
Practice address
8003 FRANKLIN FARMS DR RM 102, RICHMOND, VA 23229-5107
(301) 841-5077
Mailing address
8003 FRANKLIN FARMS DR RM 102, RICHMOND, VA 23229-5107
Taxonomy
Speciality
Code
Description
License number
State
261QH0100X
Health Service Clinic/Center
—
—
261QM0850X
Adult Mental Health Clinic/Center
—
—
261QP2000X
Physical Therapy Clinic/Center
Primary
—
—
Other
Enumeration date
01/06/2023
Last updated
09/04/2024
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