Healthcare Provider Details

I. General information

NPI: 1013683762
Provider Name (Legal Business Name): BREAD FOR THE CITY INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/20/2021
Last Update Date: 12/28/2021
Certification Date: 12/28/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1700 GOOD HOPE ROAD SE
WASHINGTON DC
20020
US

IV. Provider business mailing address

1525 7TH ST NW
WASHINGTON DC
20001-3201
US

V. Phone/Fax

Practice location:
  • Phone: 202-386-7020
  • Fax: 202-265-1970
Mailing address:
  • Phone: 202-265-2400
  • Fax: 202-265-1050

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code261QD0000X
TaxonomyDental Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code261QM0801X
TaxonomyMental Health Clinic/Center (Including Community Mental Health Center)
License Number
License Number State
# 3
Primary TaxonomyY
Taxonomy Code261QF0400X
TaxonomyFederally Qualified Health Center (FQHC)
License Number
License Number State

VIII. Authorized Official

Name: RANDI CAROL ABRAMSON
Title or Position: CHIEF MEDICAL OFFICER
Credential: MD
Phone: 202-265-2400