MEDICARE: MY OWN PLACE, INC.

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility

General Provider Information

NPI Number	:	1114131281
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	MY OWN PLACE, INC.

Provider Business Mailing Address
First Line	:	817 VARNUM ST NE
Second Line	:	SUITE 132
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2144
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	817 VARNUM ST NE
Second Line	:	SUITE 132
City	:	WASHINGTON
State	:	DC
Zip	:	20017-2144
Country	:	US
Telephone Number	:	202-580-6701
Fax Number	:

Authorized Official
Title or Position	:	EXECUTIVE DIRECTOR
Name	:	MRS. KIMBERLY SCOTT-HOPKINS
Credential	:
Telephone Number	:	202-580-6701

Provider Enumeration Date	:	05/09/2007
Last Update Date	:	02/26/2008

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