Healthcare Provider Details

I. General information

NPI: 1699941815
Provider Name (Legal Business Name): CHILDRENS HEALTH CENTER AT THEARC CHILDRENS HEALTH PROJECT OF DC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/07/2008
Last Update Date: 03/31/2023
Certification Date: 03/31/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 MISSISSIPPI AVE SE
WASHINGTON DC
20020-6120
US

IV. Provider business mailing address

111 MICHIGAN AVE NW
WASHINGTON DC
20010-2916
US

V. Phone/Fax

Practice location:
  • Phone: 202-436-3060
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QC1500X
TaxonomyCommunity Health Clinic/Center
License NumberHFD01-0208
License Number StateDC

VIII. Authorized Official

Name: PHILLICIA NELSON
Title or Position: EXECUTIVE DIRECTOR, PAYOR RELATIONS
Credential:
Phone: 301-572-6281