Healthcare Provider Details

I. General information

NPI: 1356606818
Provider Name (Legal Business Name): 412 RITTENHOUSE ST NW WASHINGTON DC 20011
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2012
Last Update Date: 07/11/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

412 RITTENHOUSE ST NW
WASHINGTON DC
20011-1329
US

IV. Provider business mailing address

412 RITTENHOUSE ST NW
WASHINGTON DC
20011-1329
US

V. Phone/Fax

Practice location:
  • Phone: 202-384-2143
  • Fax:
Mailing address:
  • Phone: 202-384-2143
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code281P00000X
TaxonomyChronic Disease Hospital
License Number163W00000X
License Number StateMD

VIII. Authorized Official

Name: MARIE AHOUEFA HOUEDOU
Title or Position: RN
Credential: NURSE
Phone: 202-384-2143