Healthcare Provider Details

I. General information

NPI: 1336301407
Provider Name (Legal Business Name): COMMUNITY ACTION GROUP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/30/2008
Last Update Date: 06/30/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3325 13TH ST SE
WASHINGTON DC
20032-4533
US

IV. Provider business mailing address

3323 13TH ST., S.E.
WASHINGTON DC
20032
US

V. Phone/Fax

Practice location:
  • Phone: 202-373-0656
  • Fax: 202-373-0665
Mailing address:
  • Phone: 202-373-0650
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QM0850X
TaxonomyAdult Mental Health Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. HAROLD GORDON
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 202-543-4558