Healthcare Provider Details

I. General information

NPI: 1639711054
Provider Name (Legal Business Name): SOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/17/2019
Last Update Date: 01/14/2021
Certification Date: 01/14/2021
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1509 N CAPITOL ST NE
WASHINGTON DC
20002-3343
US

IV. Provider business mailing address

60 O ST NW
WASHINGTON DC
20001-1259
US

V. Phone/Fax

Practice location:
  • Phone: 202-292-4491
  • Fax:
Mailing address:
  • Phone: 202-292-4491
  • 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: RALPH BOYD JR.
Title or Position: PRESIDENT/CEO
Credential:
Phone: 202-797-8806