MEDICARE: OUR COMMUNITY SUPPORT SERVICES

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	251S00000X	Community/Behavioral Health Agency

General Provider Information

NPI Number	:	1710750617
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	OUR COMMUNITY SUPPORT SERVICES

Provider Business Mailing Address
First Line	:	606 TEWKESBURY PL NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20012-2634
Country	:	US
Telephone Number	:	202-258-9100
Fax Number	:

Provider Business Practice Location Address
First Line	:	606 TEWKESBURY PL NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20012-2634
Country	:	US
Telephone Number	:	202-258-9100
Fax Number	:

Authorized Official
Title or Position	:	CEO
Name	:	KOFI GRAHAM
Credential	:
Telephone Number	:	202-258-9100

Provider Enumeration Date	:	11/01/2023
Last Update Date	:	03/10/2025

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