Healthcare Provider Details

I. General information

NPI: 1942325196
Provider Name (Legal Business Name): COLUMBIA ROAD HEALTH SERVICES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/20/2007
Last Update Date: 03/28/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1660 COLUMBIA RD NW
WASHINGTON DC
20009-3602
US

IV. Provider business mailing address

1660 COLUMBIA RD NW
WASHINGTON DC
20009-3602
US

V. Phone/Fax

Practice location:
  • Phone: 202-328-3717
  • Fax: 202-588-8101
Mailing address:
  • Phone: 202-328-3717
  • Fax: 202-588-8101

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number50002698
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number StateDC

VIII. Authorized Official

Name: SUSAN F. RIGGS
Title or Position: INTERIM CEO
Credential:
Phone: 202-328-3717