NPIMap

Organization Active NPI

Ksa Youth Foundation Inc.

  • Substance Use Disorder Rehabilitation Clinic/Center
  • Fort Washington, MD
National Provider Identifier
1013483023
Registry record updated Oct 3, 2023
On this page

Key facts

NPPES NPI Registry
Primary specialty
Substance Use Disorder Rehabilitation Clinic/CenterTaxonomy code 261QR0405X
Legal business name
KSA YOUTH FOUNDATION INC.
Practice address
10905 Fort Washington Rd Ste 105
Fort Washington, MD 20744-5844
Phone
(240) 766-4194
Fax
(301) 485-0363
NPI assigned
Oct 17, 2018
Last updated
Oct 3, 2023By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Oct 3, 2023

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Katrina Ann Wilkins-Jackson, PHDNPI 1538093661
Title
President & Ceo
Phone
(240) 766-4194

Authorized official NPPES reports the official by name only. The link goes to the one practitioner with that name whose NPPES practice address or phone number is this organization’s.

Specialties & licenses 4

Specialty (taxonomy)CodeLicenseStatePrimary
Addiction (Substance Use Disorder) Registered NurseGroup: 193200000X MULTI-SPECIALTY GROUP 163WA0400X
Addiction Medicine (Internal Medicine) PhysicianGroup: 193200000X MULTI-SPECIALTY GROUP 207RA0401X
Substance Use Disorder Rehabilitation Clinic/Center 261QR0405X Primary
Prevention ProfessionalGroup: 193200000X MULTI-SPECIALTY GROUP 405300000X

Addresses

Primary practice location

10905 Fort Washington Rd Ste 105
Fort Washington, MD 20744-5844

Mailing address

10905 Fort Washington Rd Ste 105
Fort Washington, MD 20744-5844
Phone (240) 766-4194

National Provider Directory

National Provider Directory
Tax ID family
A Plus Counseling Center8 organizations share this tax ID, including this one

Other organizations with this tax ID 7

Organizations that report the same tax identification number in the National Provider Directory.

Locations

601 Pennsylvania Ave NW
Ste 943
Washington, DC 20004

10903 Indian Head Hwy
Ste 504
Ft Washington, MD 20744
Phone (240) 493-4704

Practitioners & affiliated clinicians

Practitioners 4

Individual providers connected to this organization through Medicare benefit reassignment, Care Compare group membership or National Provider Directory roles, and the practitioner matching its NPPES authorized official.

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1539734400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1696291200000",
    "number": "1013483023",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "10905 FORT WASHINGTON RD STE 105",
            "city": "FORT WASHINGTON",
            "state": "MD",
            "postal_code": "207445844",
            "telephone_number": "240-766-4194",
            "fax_number": "301-485-0363"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "10905 FORT WASHINGTON RD STE 105",
            "city": "FORT WASHINGTON",
            "state": "MD",
            "postal_code": "207445844",
            "telephone_number": "240-766-4194",
            "fax_number": "301-485-0363"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "KSA YOUTH FOUNDATION INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2018-10-17",
        "last_updated": "2023-10-03",
        "certification_date": "2023-10-03",
        "status": "A",
        "authorized_official_last_name": "WILKINS-JACKSON",
        "authorized_official_first_name": "KATRINA",
        "authorized_official_middle_name": "ANN",
        "authorized_official_title_or_position": "PRESIDENT & CEO",
        "authorized_official_telephone_number": "240-766-4194",
        "authorized_official_credential": "PHD"
    },
    "taxonomies": [
        {
            "code": "163WA0400X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Registered Nurse, Addiction (Substance Use Disorder)",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "207RA0401X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Internal Medicine, Addiction Medicine",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QR0405X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Rehabilitation, Substance Use Disorder",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "405300000X",
            "taxonomy_group": "193200000X MULTI-SPECIALTY GROUP",
            "desc": "Prevention Professional",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Fort Washington, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 3, 2023; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.