Healthcare Provider Details

I. General information

NPI: 1588837637
Provider Name (Legal Business Name): CAPITOL HILL SUPPORTIVE SERVICES PROGRAMS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/09/2008
Last Update Date: 04/09/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 CONSTITUTION AVE NE
WASHINGTON DC
20002-6058
US

IV. Provider business mailing address

700 CONSTITUTION AVE NE
WASHINGTON DC
20002-6058
US

V. Phone/Fax

Practice location:
  • Phone: 202-547-7050
  • Fax:
Mailing address:
  • Phone: 202-547-7050
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251C00000X
TaxonomyDevelopmentally Disabled Services Day Training Agency
License Number
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number StateDC

VIII. Authorized Official

Name: PETER SHIN
Title or Position: PRESIDENT
Credential: DPM
Phone: 202-547-7050