| Blank-pages Llc | |
|
3200 Crain Hwy 203 Waldorf MD 20603-4841 | |
| (202) 567-9199 | |
| Not Available |
| Full Name | Blank-pages Llc |
|---|---|
| Speciality | Community/behavioral Health |
| Location | 3200 Crain Hwy, Waldorf, Maryland |
| Authorized Official Name and Position | Lashay Johnson (OWNER) |
| Authorized Official Contact | 2025679199 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Blank-pages Llc 4019 Night Heron Ct B Waldorf MD 20603-4673 Ph: () - | Blank-pages Llc 3200 Crain Hwy 203 Waldorf MD 20603-4841 Ph: (202) 567-9199 |
| NPI Number | 1760920292 |
|---|---|
| Provider Enumeration Date | 02/03/2017 |
| Last Update Date | 02/03/2017 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1760920292 | NPI | - | NPPES |
| 251042100 | Medicaid | MD | |
| 879798 | Other | MD | BEACON |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 251S00000X | Community/behavioral Health | LC6054 (Maryland) | Primary |
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