Provider Demographics
NPI:1881096261
Name:PROFESSIONAL SERVICES OF HOLY CROSS
Entity type:Organization
Organization Name:PROFESSIONAL SERVICES OF HOLY CROSS
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP & CFO
Authorized Official - Prefix:
Authorized Official - First Name:JULIE
Authorized Official - Middle Name:
Authorized Official - Last Name:KEESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:301-754-7201
Mailing Address - Street 1:PO BOX 531863
Mailing Address - Street 2:
Mailing Address - City:ATLANTA
Mailing Address - State:GA
Mailing Address - Zip Code:30353-1863
Mailing Address - Country:US
Mailing Address - Phone:443-274-2900
Mailing Address - Fax:443-274-2391
Practice Address - Street 1:201 RUSSELL AVE
Practice Address - Street 2:
Practice Address - City:GAITHERSBURG
Practice Address - State:MD
Practice Address - Zip Code:20877-2800
Practice Address - Country:US
Practice Address - Phone:301-557-2110
Practice Address - Fax:301-557-2120
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY CROSS HEALTH, INC.
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-17
Last Update Date:2024-09-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QH0100XAmbulatory Health Care FacilitiesClinic/CenterHealth Service
Provider Identifiers
StateIdentifier IDID TypeIssuer
MD4097289Medicaid
MD4097289Medicaid