Healthcare Provider Details

I. General information

NPI: 1083899454
Provider Name (Legal Business Name): HOLY COMFORTER-ST. CYPRIAN COMMUNITY ACTION G
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/04/2008
Last Update Date: 07/31/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

#16 17TH STREET, NE
WASHINGTON DC
20002
US

IV. Provider business mailing address

335 8TH STREET, SE
WASHINGTON DC
20003
US

V. Phone/Fax

Practice location:
  • Phone: 202-388-9182
  • Fax: 202-388-4052
Mailing address:
  • Phone: 202-543-4558
  • Fax: 202-543-4579

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number037114400
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number102500RM-023
License Number StateDC

VIII. Authorized Official

Name: MS. JANICE M DESSASO
Title or Position: PRESIDENT/CEO
Credential:
Phone: 202-543-4558