Dominion Residence of Maryland,Inc

Primary specialty

Intellectual and/or Developmental Disabilities Community Based Residential Treatment FacilityTaxonomy code 320900000X

Legal business name

DOMINION RESIDENCE OF MARYLAND,INC

Practice address

4415 Nicole Dr Ste G
Lanham, MD 20706-4357

Phone

(301) 624-9404

Fax

(301) 306-2022

NPI assigned

Oct 8, 2021

Organization subpart

No

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

Authorized official

Name

Dr. Thomas Bechem

Title

Executive Director

Phone

(301) 624-9404

Specialties & licenses 1

Addresses

Other names 1

• DOMINION RESIDENCE OF MARYLAND, INC Former legal business name

Locations

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

{
    "created_epoch": "1633651200000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1633651200000",
    "number": "1871255687",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "4415 NICOLE DR STE G",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207064357",
            "telephone_number": "301-624-9404"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "4415 NICOLE DR STE G",
            "city": "LANHAM",
            "state": "MD",
            "postal_code": "207064357",
            "telephone_number": "301-624-9404",
            "fax_number": "301-306-2022"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "DOMINION RESIDENCE OF MARYLAND,INC",
        "organizational_subpart": "NO",
        "enumeration_date": "2021-10-08",
        "last_updated": "2021-10-08",
        "certification_date": "2021-10-08",
        "status": "A",
        "authorized_official_last_name": "BECHEM",
        "authorized_official_first_name": "THOMAS",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "301-624-9404",
        "authorized_official_name_prefix": "Dr."
    },
    "taxonomies": [
        {
            "code": "320900000X",
            "taxonomy_group": "",
            "desc": "Community Based Residential Treatment Facility, Intellectual and/or Developmental Disabilities",
            "state": null,
            "license": null,
            "primary": true
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": [
        {
            "organization_name": "DOMINION RESIDENCE OF MARYLAND, INC",
            "code": "4",
            "type": "Former Legal Business Name"
        }
    ]
}

• Ruth Echick Doh
• Eliane Domfang Pouton
• Jennifer Toi Dominick
• Dominion Academy & Healthcare Services
• Dominion Family Practice, LLC
• Sonita Donfack
• David Dorin, MD
• Pierre Bashler Dorival, LGPC
• Brittney Dorsey
• Jazmine G Dorsey

• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Lanham, MD
• Providers in Lanham, MD by specialty
• Intellectual and/or Developmental Disabilities Community Based Residential Treatment Facility in Maryland

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Oct 8, 2021; 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.