Healthcare Provider Details

I. General information

NPI: 1427420389
Provider Name (Legal Business Name): URBAN ADVENTURES AT GALLERY PLACE, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/30/2015
Last Update Date: 10/30/2015
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1612 U ST NW SUITE 400
WASHINGTON DC
20009-6221
US

IV. Provider business mailing address

601 F ST NW SUITE 100
WASHINGTON DC
20004-1605
US

V. Phone/Fax

Practice location:
  • Phone: 202-393-8432
  • Fax:
Mailing address:
  • Phone: 202-393-8432
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code133V00000X
TaxonomyRegistered Dietitian
License Number
License Number State

VIII. Authorized Official

Name: LISA LIPSCOMB
Title or Position: DIRECTOR
Credential:
Phone: 202-393-8432