Pool of Bethesda Community Services, Inc.

Primary specialty

Intellectual Disabilities Intermediate Care FacilityTaxonomy code 315P00000X

Legal business name

POOL OF BETHESDA COMMUNITY SERVICES, INC.

Practice address

5020 Sunnyside Ave Ste 104
Beltsville, MD 20705-2307

Phone

(301) 220-0628

Fax

(301) 220-0629

NPI assigned

Mar 16, 2011

Last updated

Mar 16, 2011By the provider in NPPES

Organization subpart

Yes

Parent organization

FAWEMA ENTERPRISES, INC.As reported in NPPES

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

Authorized official

Name

Mrs. Susan N Konneh, RN

Title

President

Phone

(301) 220-0628

Specialties & licenses 1

Addresses

Locations

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

{
    "created_epoch": "1300233600000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1300233600000",
    "number": "1568761526",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "5020 SUNNYSIDE AVE STE 104",
            "city": "BELTSVILLE",
            "state": "MD",
            "postal_code": "207052307",
            "telephone_number": "301-220-0628",
            "fax_number": "301-220-0629"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "5020 SUNNYSIDE AVE STE 104",
            "city": "BELTSVILLE",
            "state": "MD",
            "postal_code": "207052307",
            "telephone_number": "301-220-0628",
            "fax_number": "301-220-0629"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "POOL OF BETHESDA COMMUNITY SERVICES, INC.",
        "organizational_subpart": "YES",
        "parent_organization_legal_business_name": "FAWEMA ENTERPRISES, INC.",
        "enumeration_date": "2011-03-16",
        "last_updated": "2011-03-16",
        "status": "A",
        "authorized_official_last_name": "KONNEH",
        "authorized_official_first_name": "SUSAN",
        "authorized_official_middle_name": "N",
        "authorized_official_title_or_position": "PRESIDENT",
        "authorized_official_telephone_number": "301-220-0628",
        "authorized_official_name_prefix": "Mrs.",
        "authorized_official_credential": "RN"
    },
    "taxonomies": [
        {
            "code": "315P00000X",
            "taxonomy_group": "",
            "desc": "Intermediate Care Facility, Intellectual Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

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• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Mar 16, 2011; 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.