KSA YOUTH FOUNDATION INC. (NPI# 1013483023) is a health care provider registered in Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES).
| Nation Provider ID (NPI) | 1013483023 |
| Entity Type | Organization |
| Organization Name | KSA YOUTH FOUNDATION INC. |
| Practice Address |
10903 Indian Head Hwy Ste 504 Fort Washington MD 20744-4012 |
| Practice Telephone | 2407664194 |
| Practice Fax Number | 3014850363 |
| Mailing Telephone | 2407664194 |
| Mailing Fax Number | 3014850363 |
| Enumeration Date | 2018-10-17 |
| Last Update Date | 2018-10-17 |
| Authorized Official Name | KATRINA ANN WILKINS-JACKSON (PRESIDENT & CEO) |
| Authorized Official Telephone | 2407664194 |
| Authorized Official Credential | PHD |
| Is Organization Subpart | N |
| Primary | Taxonomy Code | Classification | License Number | License State | Taxonomy Group |
|---|---|---|---|---|---|
| N | 163WA0400X |
Registered Nurse Specialization: Addiction (Substance Use Disorder) |
Nursing Service Providers | ||
| N | 207RA0401X |
Internal Medicine Specialization: Addiction Medicine |
Allopathic & Osteopathic Physicians | ||
| N | 405300000X | Prevention Professional | Other Service Providers | ||
| Y | 261QR0405X |
Clinic/Center Specialization: Rehabilitation, Substance Use Disorder |
Ambulatory Health Care Facilities |
| State | Issuer | Identifier | Type Code |
|---|---|---|---|
| MD | 132375000 | 05 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1922568435 | Ksa Youth Foundation Inc. | Clinic/Center | 10351 Southern Maryland Blvd Ste 101, Dunkirk, MD 20754-9510 | 2019-03-21 |
| 1720551450 | Ksa Youth Foundation Inc. | Clinic/Center | 2829 Chesapeake Beach Rd W, Dunkirk, MD 20754-9526 | 2019-01-04 |
| 1598267700 | Ksa Youth Foundation Inc. | Counselor | 10903 Indian Head Hwy Ste 504, Fort Washington, MD 20744-4012 | 2018-03-03 |
| 1447723176 | Ksa Youth Foundation Inc. | Clinic/Center | 7600 Osler Dr Ste 105, Towson, MD 21204-7705 | 2019-01-04 |
| 1770052409 | Ksa Youth Foundation Inc. | Non-emergency Medical Transport (VAN) | 10903 Indian Head Hwy Ste 504, Fort Washington, MD 20744-4012 | 2018-11-26 |
| Entity Type | Entity Name | Entity Address |
|---|---|---|
| Virginia Business Entities | KSA Youth Foundation Inc. | 17806 Merino Drive, Accokeek, Maryland 20607 |
| Street Address |
10903 INDIAN HEAD HWY STE 504 |
| City | FORT WASHINGTON |
| State | MD |
| Zip Code | 20744-4012 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1598267700 | Ksa Youth Foundation Inc. | Counselor | 10903 Indian Head Hwy Ste 504, Fort Washington, MD 20744-4012 | 2018-03-03 |
| 1770052409 | Ksa Youth Foundation Inc. | Non-emergency Medical Transport (VAN) | 10903 Indian Head Hwy Ste 504, Fort Washington, MD 20744-4012 | 2018-11-26 |
| 1417423096 | Charlena Young | Counselor | 10903 Indian Head Hwy Ste 504, Fort Washington, MD 20744-4012 | 2018-10-22 |
| 1023594298 | Melvin Johnson | Counselor | 10903 Indian Head Hwy Ste 504, Fort Washington, MD 20744-4012 | 2018-07-11 |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1558823807 | Sybil Canales | Nurse Practitioner | 8507 Oxon Hill Rd., Suite 200, Fort Washington, MD 20744 | 2019-04-04 |
| 1700372141 | Avia Barrett-powell | Nurse Practitioner | 10709 Md-210 Suite D, Fort Wasshington, MD 20744 | 2018-07-09 |
| 1285125047 | Darlene Williams-prades | Specialist | 9400 Livingston Rd Ste 400, Ft Washington, MD 20744 | 2018-05-28 |
| 1609371277 | My Girl's Place Pllc | Social Worker | 8507 Oxon Hill Rd Ste 200-s35, Fort Washington, MD 20744 | 2018-03-27 |
| 1720580293 | Janet C Nwaogu | Licensed Practical Nurse | 6856 Eastern Avenue Suite 320 A, Washington (and Vicinity), MD 20744 | 2018-03-01 |
| 1174040505 | Sharon Ray | Specialist | 12303 Parkton St, Fort Washington, MD 20744 | 2017-08-25 |
| 1013433069 | Carmilla Wheeler | Specialist/Technologist | 12515 Langner Drive, Fort Washington, MD 20744 | 2017-08-21 |
| 1194266627 | Brian Cooper I | Home Health Aide | 9008 Branchview Dr, Fort Washington, MD 20744 | 2017-03-16 |
| 1467803973 | Saint Pharmacy, Inc | Pharmacy | 5608 Saint Barnabas Road, Suite 120, Fort Washington, MD 20744 | 2016-06-27 |
| 1962802959 | Eric Fosung Fotang | Pharmacist | 8201 Oxon Hill Road, Fort Washington, MD 20744 | 2014-08-27 |
| Find all providers in zip 20744 | ||||
| Taxonomy Code | 261QR0405X |
| Grouping | Ambulatory Health Care Facilities |
| Classification | Clinic/Center |
| Specialization | Rehabilitation, Substance Use Disorder |
| Definition to come... |
| NPI | Name | Taxonomy | Address | Enumeration |
|---|---|---|---|---|
| 1992251326 | Life of Purpose - Pennsylvania | Clinic/Center | 1035 Virginia Dr Ste 120, Fort Washington, PA 19034-3103 | 2016-08-26 |
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| 1881203792 | Sabinas House LLC | Clinic/Center | 3325 Shannon Dr, Baltimore, MD 21213-1823 | 2020-07-27 |
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| 1598374407 | Sabinas House LLC | Clinic/Center | 605 Springfield Ave, Baltimore, MD 21212-4832 | 2020-07-27 |
| Find all providers with the same taxonomy | ||||
| City | FORT WASHINGTON |
| Zip Code | 20744 |
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| Data Provider | Centers for Medicare & Medicaid Services (CMS), National Plan and Provider Enumeration System (NPPES) |
| Jurisdiction | Medicare & Medicaid |
This dataset includes 5.44 million covered health care providers and all health plans and health care clearinghouses, registered with CMA NPPES. Each provider is registered with National Provider Identifier (NPI), full name, status, address, taxonomy, other identifiers, etc.