Healthcare Provider Details

I. General information

NPI: 1417755984
Provider Name (Legal Business Name): YELLOW DOORS 2119
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/03/2025
Last Update Date: 03/03/2025
Certification Date: 03/03/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1842 PROVIDENCE ST NE APT 1
WASHINGTON DC
20002-1770
US

IV. Provider business mailing address

3904 NOYES CIR APT 103
RANDALLSTOWN MD
21133-2746
US

V. Phone/Fax

Practice location:
  • Phone: 202-320-2556
  • Fax:
Mailing address:
  • Phone: 202-320-2556
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code251S00000X
TaxonomyCommunity/Behavioral Health Agency
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code385HR2050X
TaxonomyRespite Care Camp
License Number
License Number State

VIII. Authorized Official

Name: HELENE MOUDIO
Title or Position: CEO
Credential:
Phone: 202-320-2556