Healthcare Provider Details

I. General information

NPI: 1427544436
Provider Name (Legal Business Name): DC YOUTH EMPOWERMENT
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2018
Last Update Date: 03/21/2022
Certification Date: 03/21/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

50 HAWAII AVE NE APT 111
WASHINGTON DC
20011-4922
US

IV. Provider business mailing address

50 HAWAII AVE NE APT 111
WASHINGTON DC
20011-4922
US

V. Phone/Fax

Practice location:
  • Phone: 202-813-9452
  • Fax:
Mailing address:
  • Phone: 202-813-9452
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code172V00000X
TaxonomyCommunity Health Worker
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. GARY H JOHNSON JR.
Title or Position: PRESIDENT
Credential:
Phone: 202-813-9452