Healthcare Provider Details

I. General information

NPI: 1629237037
Provider Name (Legal Business Name): CHILDRENS HEALTH CENTER AT SHAW
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/02/2008
Last Update Date: 06/02/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2200 11TH STREET NW
WASHINGTON DC
20001
US

IV. Provider business mailing address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 202-476-5500
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberHFD010208
License Number StateDC

VIII. Authorized Official

Name: SUSAN PFENNIG
Title or Position: MANAGER
Credential:
Phone: 202-476-4447