| Goshen Ignite | |
|
4810 Jefferson St Lanham MD 20706-4204 | |
| (240) 548-0728 | |
| Not Available |
| Full Name | Goshen Ignite |
|---|---|
| Speciality | Clinic/center - Mental Health (including Community Mental Health Center) |
| Location | 4810 Jefferson St, Lanham, Maryland |
| Authorized Official Name and Position | Juliet Numfor (CEO) |
| Authorized Official Contact | 2405480728 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
| Goshen Ignite 4810 Jefferson St Lanham MD 20706-4204 Ph: () - | Goshen Ignite 4810 Jefferson St Lanham MD 20706-4204 Ph: (240) 548-0728 |
| NPI Number | 1932904430 |
|---|---|
| Provider Enumeration Date | 02/18/2025 |
| Last Update Date | 02/18/2025 |
| Certification Date | 02/18/2025 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1932904430 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 261QM0801X | Clinic/center - Mental Health (including Community Mental Health Center) | (* (Not Available)) | Primary |
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