Healthcare Provider Details

I. General information

NPI: 1316387046
Provider Name (Legal Business Name): HUMILITY OUTREACH MISSIONARY MINISTRIES, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/26/2013
Last Update Date: 06/26/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4312 HALLEY TER SE
WASHINGTON DC
20032-5838
US

IV. Provider business mailing address

2200 TUCKER RD
FORT WASHINGTON MD
20744-3517
US

V. Phone/Fax

Practice location:
  • Phone: 202-373-0550
  • Fax: 202-373-5540
Mailing address:
  • Phone: 240-882-8068
  • Fax: 202-373-5540

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320800000X
TaxonomyMental Illness Community Based Residential Treatment Facility
License Number1049
License Number StateDC

VIII. Authorized Official

Name: MR. DAVID AARON GILMORE
Title or Position: CHIEF EXECUTIVE OFFICER
Credential:
Phone: 240-882-8068