Healthcare Provider Details

I. General information

NPI: 1053005157
Provider Name (Legal Business Name): HIBISCUS HEALTH INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/05/2023
Last Update Date: 11/11/2024
Certification Date: 11/11/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7144 13TH PL NW STE 2200
WASHINGTON DC
20012-2358
US

IV. Provider business mailing address

70 N ST SE APT 813
WASHINGTON DC
20003-4902
US

V. Phone/Fax

Practice location:
  • Phone: 212-729-1089
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code103T00000X
TaxonomyPsychologist
License Number
License Number State
# 2
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QP2300X
TaxonomyPrimary Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: CANDICE ARNOLD
Title or Position: DIRECTOR OF REVENUE OPERATIONS
Credential:
Phone: 540-907-2023