Healthcare Provider Details

I. General information

NPI: 1023821980
Provider Name (Legal Business Name): CENTRONIA, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2025
Last Update Date: 08/07/2025
Certification Date: 08/07/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1420 COLUMBIA RD NW FL 4
WASHINGTON DC
20009-4779
US

IV. Provider business mailing address

1420 COLUMBIA RD NW FL 4
WASHINGTON DC
20009-4779
US

V. Phone/Fax

Practice location:
  • Phone: 202-925-6424
  • Fax:
Mailing address:
  • Phone: 202-925-6424
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ANDRES ALEJANDRO CRUCET-CHOI
Title or Position: PROGRAM MANAGER
Credential:
Phone: 202-925-6424