Healthcare Provider Details

I. General information

NPI: 1720200405
Provider Name (Legal Business Name): NATIONAL CHILDREN'S CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/03/2007
Last Update Date: 04/18/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3400 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20032-1542
US

IV. Provider business mailing address

6200 2ND ST NW
WASHINGTON DC
20011-1426
US

V. Phone/Fax

Practice location:
  • Phone: 202-279-4900
  • Fax: 202-279-4905
Mailing address:
  • Phone: 202-722-2300
  • Fax: 202-722-2563

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code2251P0200X
TaxonomyPediatric Physical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225XP0200X
TaxonomyPediatric Occupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code390200000X
TaxonomyStudent in an Organized Health Care Education/Training Program
License Number
License Number State

VIII. Authorized Official

Name: MICHELE DURBIN
Title or Position: CFO
Credential:
Phone: 202-722-2356