Healthcare Provider Details

I. General information

NPI: 1497930796
Provider Name (Legal Business Name): GREATER MT. CALVARY HOLY CHURCH
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

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

III. Provider practice location address

802 RHODE ISLAND AVE NE
WASHINGTON DC
20018-1732
US

IV. Provider business mailing address

802 RHODE ISLAND AVE NE
WASHINGTON DC
20018-1732
US

V. Phone/Fax

Practice location:
  • Phone: 202-832-8336
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code324500000X
TaxonomySubstance Abuse Rehabilitation Facility
License Number
License Number StateDC

VIII. Authorized Official

Name: MR. DWIGHT D ELLARD
Title or Position: CHIEF OPERATION OFFICER
Credential:
Phone: 202-529-4547