Healthcare Provider Details

I. General information

NPI: 1386164705
Provider Name (Legal Business Name): ECKINGTON HOUSE MENTAL HEALTH SERVICE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2017
Last Update Date: 08/21/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3030 30TH ST SE
WASHINGTON DC
20020-1674
US

IV. Provider business mailing address

217 T ST NE
WASHINGTON DC
20002-1530
US

V. Phone/Fax

Practice location:
  • Phone: 202-870-0701
  • Fax: 202-506-3522
Mailing address:
  • Phone: 202-870-0701
  • Fax: 202-506-3522

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code385HR2060X
TaxonomyChild Intellectual and/or Developmental Disabilities Respite Care
License Number
License Number State
# 4
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License Number
License Number State

VIII. Authorized Official

Name: JOYCE STEPHENS
Title or Position: CEO
Credential: JURIS DOCTORATE
Phone: 202-870-0701