MEDICARE: SERVANT OF ALL

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	:	1205081635
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	SERVANT OF ALL

Provider Business Mailing Address
First Line	:	3107 WESTOVER DR SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-3719
Country	:	US
Telephone Number	:	202-583-3508
Fax Number	:

Provider Business Practice Location Address
First Line	:	3107 WESTOVER DR SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20020-3719
Country	:	US
Telephone Number	:	202-583-3508
Fax Number	:

Authorized Official
Title or Position	:	PRESIDENT/ CEO
Name	:	MR. MORRIS DICKERSON
Credential	:
Telephone Number	:	202-438-7439

Provider Enumeration Date	:	11/26/2008
Last Update Date	:	11/26/2008

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Directions to “SERVANT OF ALL ” Practice Location

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