Healthcare Provider Details

I. General information

NPI: 1275903700
Provider Name (Legal Business Name): COMMUNITY WELLNESS VENTURES, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/27/2015
Last Update Date: 11/24/2025
Certification Date: 11/24/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1930 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20020-7006
US

IV. Provider business mailing address

1930 MARTIN LUTHER KING JR AVE SE
WASHINGTON DC
20020-7006
US

V. Phone/Fax

Practice location:
  • Phone: 202-450-5822
  • Fax: 202-450-5822
Mailing address:
  • Phone: 202-450-5822
  • Fax: 202-450-5822

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License NumberMD13456
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberLG100230
License Number StateDC

VIII. Authorized Official

Name: DR. ROD WILLIAMS
Title or Position: COO
Credential:
Phone: 202-450-5822