Healthcare Provider Details

I. General information

NPI: 1831351022
Provider Name (Legal Business Name): MT&G ENTERPRISE, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/28/2008
Last Update Date: 07/08/2020
Certification Date: 07/08/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

201 20TH ST NE
WASHINGTON DC
20002-6721
US

IV. Provider business mailing address

201 20TH ST NE APT 2
WASHINGTON DC
20002-6721
US

V. Phone/Fax

Practice location:
  • Phone: 202-257-9830
  • Fax: 301-283-0986
Mailing address:
  • Phone: 202-257-9830
  • Fax: 301-283-0986

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QD1600X
TaxonomyDevelopmental Disabilities Clinic/Center
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number StateDC

VIII. Authorized Official

Name: NATAKA GAIL WILSON
Title or Position: CEO/OWNER
Credential:
Phone: 202-257-9830