Provider Demographics
NPI:1609697804
Name:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Entity type:Organization
Organization Name:MONTGOMERY COUNTY MARYLAND GOVERNMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:MRS
Authorized Official - First Name:JAMEELAH
Authorized Official - Middle Name:
Authorized Official - Last Name:JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:JM-HL, MPH, MBA-HCM
Authorized Official - Phone:240-773-1211
Mailing Address - Street 1:401 HUNGERFORD DR FL 6
Mailing Address - Street 2:
Mailing Address - City:ROCKVILLE
Mailing Address - State:MD
Mailing Address - Zip Code:20850-4154
Mailing Address - Country:US
Mailing Address - Phone:240-773-1211
Mailing Address - Fax:
Practice Address - Street 1:1500 E GUDE DR
Practice Address - Street 2:
Practice Address - City:ROCKVILLE
Practice Address - State:MD
Practice Address - Zip Code:20850-5307
Practice Address - Country:US
Practice Address - Phone:240-777-0311
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2024-10-21
Last Update Date:2024-11-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder