Healthcare Provider Details

I. General information

NPI: 1659409795
Provider Name (Legal Business Name): EXTENDED HOUSE, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/01/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

810 14TH ST NE
WASHINGTON DC
20002-5004
US

IV. Provider business mailing address

1017 BRENTWOOD RD NE
WASHINGTON DC
20018-1039
US

V. Phone/Fax

Practice location:
  • Phone: 202-396-2272
  • 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 State

VIII. Authorized Official

Name: ANITA D MORTON
Title or Position: BUSINESS MANAGER
Credential:
Phone: 202-636-4041