Healthcare Provider Details

I. General information

NPI: 1265095210
Provider Name (Legal Business Name): NO JUNK FOOD ZONE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/16/2019
Last Update Date: 01/30/2020
Certification Date: 01/30/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

800 MAINE AVE SW STE 200
WASHINGTON DC
20024-2811
US

IV. Provider business mailing address

800 MAINE AVE SW STE 200
WASHINGTON DC
20024-2811
US

V. Phone/Fax

Practice location:
  • Phone: 202-660-1460
  • Fax:
Mailing address:
  • Phone: 202-660-1460
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code174H00000X
TaxonomyHealth Educator
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251K00000X
TaxonomyPublic Health or Welfare Agency
License Number
License Number State
# 4
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 5
Primary TaxonomyN
Taxonomy Code261QH0100X
TaxonomyHealth Service Clinic/Center
License Number
License Number State
# 6
Primary TaxonomyN
Taxonomy Code261QM1300X
TaxonomyMulti-Specialty Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: ROSANE ST PAUL
Title or Position: DIRECTOR
Credential:
Phone: 202-660-1460