MEDICARE: URBAN ADVENTURES AT GALLERY PLACE, LLC

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	133V00000X	Registered Dietitian

General Provider Information

NPI Number	:	1427420389
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	URBAN ADVENTURES AT GALLERY PLACE, LLC

Provider Business Mailing Address
First Line	:	601 F ST NW
Second Line	:	SUITE 100
City	:	WASHINGTON
State	:	DC
Zip	:	20004-1605
Country	:	US
Telephone Number	:	202-393-8432
Fax Number	:

Provider Business Practice Location Address
First Line	:	1612 U ST NW
Second Line	:	SUITE 400
City	:	WASHINGTON
State	:	DC
Zip	:	20009-6221
Country	:	US
Telephone Number	:	202-393-8432
Fax Number	:

Authorized Official
Title or Position	:	DIRECTOR
Name	:	LISA LIPSCOMB
Credential	:
Telephone Number	:	202-393-8432

Provider Enumeration Date	:	10/30/2015
Last Update Date	:	10/30/2015

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