Healthcare Provider Details

I. General information

NPI: 1366768194
Provider Name (Legal Business Name): ST JOHN'S COMMUNITY SERVICE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/19/2010
Last Update Date: 04/19/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2201 WISCONSIN AVE NW SUITE 120
WASHINGTON DC
20007-4105
US

IV. Provider business mailing address

2201 WISCONSIN AVE NW SUITE 120
WASHINGTON DC
20007-4129
US

V. Phone/Fax

Practice location:
  • Phone: 202-237-6500
  • Fax: 202-237-6352
Mailing address:
  • Phone: 202-237-6500
  • Fax: 202-237-6352

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code320900000X
TaxonomyIntellectual and/or Developmental Disabilities Community Based Residential Treatment Facility
License NumberHFD12-0070
License Number StateDC

VIII. Authorized Official

Name: MR. ARTHUR GINSBERG
Title or Position: STATE DIRECTOR
Credential:
Phone: 202-237-6500