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NPI Code Detail

MEDICARE: EAST OF THE RIVER CLERGY POLICE COMMUNITY PARTNERSHIP, INC.

MEDICARE: EAST OF THE RIVER CLERGY POLICE COMMUNITY PARTNERSHIP, 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
1251S00000XCommunity/Behavioral Health Agency52227DC

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
152227701012073OTHERDCBUSINESS LICENSE

General Provider Information

NPI Number : 1952661852
Entity Type Code : Organization
Provider Name (Legal Business Name) : EAST OF THE RIVER CLERGY POLICE COMMUNITY PARTNERSHIP, INC.
Provider Business Mailing Address
First Line : 4115 1ST ST SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20032-2815
Country : US
Telephone Number : 202-373-5767
Fax Number : 202-373-5769
Provider Business Practice Location Address
First Line : 4115 1ST ST SE
Second Line :
City : WASHINGTON
State : DC
Zip : 20032-2815
Country : US
Telephone Number : 202-373-5767
Fax Number : 202-373-5769
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MR. DONALD ISAAC
Credential :
Telephone Number : 202-373-5667
Provider Enumeration Date : 05/24/2012
Last Update Date : 05/24/2012

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