NPI 1700321957

Jacobs Promise

Organisation Exclusive Provider Organization Bowie, MD

Practice location

Address: 15480 Annapolis Rd STE 202, Bowie, MD 20715-1803
Phone: (301) 392-7075

Authorised official

Name: Erin Winston
Title: Bcba
Phone: (301) 576-5487

Registered specialties

Exclusive Provider Organization Primary

Managed Care Organizations Taxonomy 302F00000X Licence ZZ 103K00000X (MD)

Other Exclusive Provider Organization providers in Maryland →

Registry record

NPI: 1700321957
Entity type: Organization
NPI issued: 26 Dec 2016
Record last updated: 26 Dec 2016

Reproduced from NPPES, the federal provider registry. The date above is when the provider last updated their own entry, not when we fetched it - a record can be years old and still current in the registry.