Healthcare Provider Details

I. General information

NPI: 1104095991
Provider Name (Legal Business Name): PEDIATRIC AIDS HIV CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/26/2008
Last Update Date: 02/26/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

450 M ST NW
WASHINGTON DC
20001-4606
US

IV. Provider business mailing address

450 M ST NW
WASHINGTON DC
20001-4606
US

V. Phone/Fax

Practice location:
  • Phone: 202-347-5366
  • Fax: 202-628-3021
Mailing address:
  • Phone: 202-347-5366
  • Fax: 202-628-3021

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code102X00000X
TaxonomyPoetry Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code343900000X
TaxonomyNon-emergency Medical Transport (VAN)
License Number
License Number State
# 6
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number State

VIII. Authorized Official

Name: MRS. KHADIJAH A TRIBBLE
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 202-347-5366