NPIMap

Organization Active NPI

Family Health Center

  • Specialist
  • Hyattsville, MD
National Provider Identifier
1316126121
Registry record updated Dec 7, 2020
On this page

Key facts

NPPES NPI Registry
Primary specialty
SpecialistTaxonomy code 174400000X
License
LC0295 Issued in MD
Legal business name
FAMILY HEALTH CENTER
Practice address
3415 Hamilton St
Suite 9
Hyattsville, MD 20782-3953
Phone
(301) 779-2461
Fax
(301) 779-6095
NPI assigned
Oct 29, 2007
Last updated
Dec 7, 2020By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Dec 7, 2020

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

Authorized official

Name
Dr. Bruke Tadesse, PSYD, LCPC, CASNPI 1306861752
Title
Executive Director
Phone
(301) 779-2461

Authorized official NPPES reports the official by name only. The link goes to the one practitioner connected to this organization with that name.

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Adult Mental Health Clinic/Center 261QM0850X NU
Addiction (Substance Use Disorder) Psychologist 103TA0400X NU
Specialist 174400000X LC0295 MD Primary

Addresses

Primary practice location

3415 Hamilton St
Suite 9
Hyattsville, MD 20782-3953

Mailing address

3415 Hamilton St
Suite 9
Hyattsville, MD 20782-3953
Phone (301) 779-2461

Other identifiers 1

IdentifierTypeStateIssuer
410291600MedicaidMD

National Provider Directory

National Provider Directory
Tax ID family
Family Health Center2 organizations share this tax ID, including this one

Other organizations with this tax ID 1

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

Locations

3415 Hamilton St
Ste 9
West Hyattsville, MD 20782
Phone (301) 538-5659

Practitioners & affiliated clinicians

Practitioners 2

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": "1193616000000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1607299200000",
    "number": "1316126121",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "3415 HAMILTON ST",
            "address_2": "SUITE 9",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207823953",
            "telephone_number": "301-779-2461",
            "fax_number": "301-779-6095"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "3415 HAMILTON ST",
            "address_2": "SUITE 9",
            "city": "HYATTSVILLE",
            "state": "MD",
            "postal_code": "207823953",
            "telephone_number": "301-779-2461",
            "fax_number": "301-779-6095"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "FAMILY HEALTH CENTER",
        "organizational_subpart": "NO",
        "enumeration_date": "2007-10-29",
        "last_updated": "2020-12-07",
        "certification_date": "2020-12-07",
        "status": "A",
        "authorized_official_last_name": "TADESSE",
        "authorized_official_first_name": "BRUKE",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "301-779-2461",
        "authorized_official_name_prefix": "Dr.",
        "authorized_official_credential": "PSYD, LCPC, CAS"
    },
    "taxonomies": [
        {
            "code": "261QM0850X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Adult Mental Health",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "103TA0400X",
            "taxonomy_group": "",
            "desc": "Psychologist, Addiction (Substance Use Disorder)",
            "state": "NU",
            "license": null,
            "primary": false
        },
        {
            "code": "174400000X",
            "taxonomy_group": "",
            "desc": "Specialist",
            "state": "MD",
            "license": "LC0295",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "410291600",
            "state": "MD"
        }
    ],
    "endpoints": [],
    "other_names": []
}

Other providers in Hyattsville, MD

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Dec 7, 2020; 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.