Healthcare Provider Details

I. General information

NPI: 1891129938
Provider Name (Legal Business Name): HARVARD KNOLLS
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/26/2013
Last Update Date: 08/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2628 4TH ST NE
WASHINGTON DC
20002-1206
US

IV. Provider business mailing address

2628 4TH ST NE
WASHINGTON DC
20002-1206
US

V. Phone/Fax

Practice location:
  • Phone: 202-450-3493
  • Fax: 202-450-3528
Mailing address:
  • Phone: 202-450-3493
  • Fax: 202-450-3528

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320700000X
TaxonomyPhysical Disabilities Residential Treatment Facility
License Number
License Number StateDC

VIII. Authorized Official

Name: CHANTEL JANVIER KENNEDY
Title or Position: RESIDENCE DIRECTOR
Credential:
Phone: 240-899-2514