Healthcare Provider Details

I. General information

NPI: 1447797352
Provider Name (Legal Business Name): WAY OF THE WORD, CDC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/30/2017
Last Update Date: 01/30/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1301 RIDGE PL SE
WASHINGTON DC
20020-6923
US

IV. Provider business mailing address

851 YUMA ST SE
WASHINGTON DC
20032-3974
US

V. Phone/Fax

Practice location:
  • Phone: 202-854-8050
  • Fax:
Mailing address:
  • Phone: 202-854-8050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251B00000X
TaxonomyCase Management Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code251V00000X
TaxonomyVoluntary or Charitable Agency
License Number
License Number State

VIII. Authorized Official

Name: GLEN STAPLES
Title or Position: CEO
Credential:
Phone: 301-370-9855