Healthcare Provider Details

I. General information

NPI: 1215155502
Provider Name (Legal Business Name): SAINT PAUL BAPTIST CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/23/2007
Last Update Date: 07/21/2022
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1611 BRENTWOOD RD NE
WASHINGTON DC
20018-1829
US

IV. Provider business mailing address

1611 BRENTWOOD RD NE
WASHINGTON DC
20018-1829
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-1218
  • Fax: 202-526-0883
Mailing address:
  • Phone: 202-832-1218
  • Fax: 202-526-0883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number
License Number StateDC

VIII. Authorized Official

Name: MS. MIRIAM HILLIARD PEACE
Title or Position: DIRECTOR
Credential:
Phone: 202-832-1218