Healthcare Provider Details

I. General information

NPI: 1821273111
Provider Name (Legal Business Name): HOLY COMFORTER-ST. CYPRIAN COMMUNITY ACTION GROUP
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

1238 PENNSYLVANIA AVE SE
WASHINGTON DC
20003-2226
US

IV. Provider business mailing address

901 PENNSYLVANIA AVE SE
WASHINGTON DC
20003-2141
US

V. Phone/Fax

Practice location:
  • Phone: 202-543-4750
  • Fax: 202-543-4754
Mailing address:
  • Phone: 202-543-4558
  • Fax: 202-543-4579

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. HAROLD J GORDON
Title or Position: PRESIDENT/CEO
Credential:
Phone: 202-543-4558