Healthcare Provider Details

I. General information

NPI: 1427228105
Provider Name (Legal Business Name): CLEAN AND SOBER STREETS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/10/2008
Last Update Date: 05/12/2022
Certification Date: 05/12/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

425 2ND ST NW 2 NORTH
WASHINGTON DC
20001-2003
US

IV. Provider business mailing address

PO BOX 77281
WASHINGTON DC
20013-8281
US

V. Phone/Fax

Practice location:
  • Phone: 202-783-7343
  • Fax: 202-628-1183
Mailing address:
  • Phone: 202-236-4362
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QR0405X
TaxonomySubstance Use Disorder Rehabilitation Clinic/Center
License Number102500R008
License Number StateDC
# 2
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. HENRY PRIMES PIERCE III
Title or Position: EXECUTIVE DIRECTOR
Credential:
Phone: 202-236-4362