KSA YOUTH FOUNDATION INC. NPI 1013483023

NPI Information

NPI: 1013483023
Provider Name: KSA YOUTH FOUNDATION INC.
Classification: Clinic/Center - 261QR0405X
Entity Type: Organization

Specialization: Rehabilitation, Substance Use Disorder

Address:
10905 FORT WASHINGTON RD STE 105
FORT WASHINGTON, MD
ZIP 20744
Phone: (240) 766-4194
Get Directions

KSA YOUTH FOUNDATION INC. is a rehabilitation and substance use disorder clinic center in Fort Washington, MD. KSA YOUTH FOUNDATION INC. NPI is 1013483023. The provider is registered as an organization entity type and is a multi-specialty group.

The provider's business location address is:

10905 FORT WASHINGTON RD STE 105
FORT WASHINGTON, MD
ZIP 20744-844
Phone: (240) 766-4194
Fax: (301) 485-0363

The provider's authorized official is Katrina Ann Wilkins-jackson .
The authorized official title is President & Ceo and has the following contact phone number (240) 766-4194.

The enumeration date for this NPI number is 10/17/2018 and was last updated on 10/3/2023.

Taxonomy Codes

The NPI record includes the healthcare provider taxonomy classification, state license number and state of licensure. The following information regarding the scope of practice of this provider is available:

No.	Taxonomy Code	Taxonomy Clasification	Taxonomy Specialization	Primary
1	163WA0400X	Registered Nurse	Addiction (Substance Use Disorder)	No
2	207RA0401X	Internal Medicine	Addiction Medicine	No
3	405300000X	Prevention Professional		No
4	261QR0405X	Clinic/Center	Rehabilitation, Substance Use Disorder	Yes

Other Identifiers

The following information regarding additional identifiers associated to this NPI record includes the other identifier number, identifier type, identifier state and issuer.

No.	Other Provider Identifier	Other Provider Identifier Type	Other Provider Identifier State	Other Provider Identifier Issuer
1	132375000	MEDICAID	MARYLAND

What is NPI?

NPI stands for National Provider Identifier. The NPI is a 10-digit identification number that is completely unique. The NPI number by itself does not contain any identifiable information such as a provider’s speciality or location. The NPI is assigned to individuals or organizacions for their lifespan and it is independent of key provider information type updates like a change of practices, location or speciality.

This page was last updated on: 5/5/2024

NPI Synchronization or Removal

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