Healthcare Provider Details

I. General information

NPI: 1871549949
Provider Name (Legal Business Name): WISCONSIN AVE PSYCHIATRIC CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/26/2006
Last Update Date: 06/04/2020
Certification Date: 06/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4228 WISCONSIN AVE NW
WASHINGTON DC
20016-2138
US

IV. Provider business mailing address

4228 WISCONSIN AVE NW
WASHINGTON DC
20016-2138
US

V. Phone/Fax

Practice location:
  • Phone: 202-885-5600
  • Fax:
Mailing address:
  • Phone: 202-885-5600
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2084P0800X
TaxonomyPsychiatry Physician
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code363LP0808X
TaxonomyPsychiatric/Mental Health Nurse Practitioner
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code283Q00000X
TaxonomyPsychiatric Hospital
License NumberHFD01-0011
License Number StateDC

VIII. Authorized Official

Name: STEVE FILTON
Title or Position: VICE PRESIDENT
Credential:
Phone: 610-768-3482