MEDICARE: HOLY COMFORTER-ST. CYPRIAN COMMUNITY ACTION GROUP

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	324500000X	Substance Abuse Rehabilitation Facility		DC

General Provider Information

NPI Number	:	1215113097
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	HOLY COMFORTER-ST. CYPRIAN COMMUNITY ACTION GROUP

Provider Business Mailing Address
First Line	:	901 PENNSYLVANIA AVE SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20003-2141
Country	:	US
Telephone Number	:	202-543-4558
Fax Number	:	202-543-4579

Provider Business Practice Location Address
First Line	:	3323 13TH ST SE
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20032-4533
Country	:	US
Telephone Number	:	202-373-0650
Fax Number	:	202-373-0655

Authorized Official
Title or Position	:	PRESIDENT/CEO
Name	:	MR. HAROLD J GORDON
Credential	:
Telephone Number	:	202-543-4558

Provider Enumeration Date	:	01/11/2008
Last Update Date	:	01/11/2008

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Directions to “HOLY COMFORTER-ST. CYPRIAN COMMUNITY ACTION GROUP ” Practice Location

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