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General NPI Number Information
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NPI Number | 1063643880
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Entity Type | Organization
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Legal Business Name | DEPARTMENT OF YOUTH REHABILITATION SERVICES
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Dates
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Enumeration Date | 07/28/2009
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Last Update Date | 07/28/2009
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Provider Practice Location Address
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Address Line | 1000 MOUNT OLIVET RD NE
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City | WASHINGTON
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State | DC
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Zip | 20002-2210
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Country | US
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Telephone | 202-576-8405
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Fax | 202-576-8457
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Provider Business Mailing Address
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Address Line | 1000 MOUNT OLIVET RD NE
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City | WASHINGTON
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State | DC
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Zip | 20002-2210
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Country | US
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Telephone | 202-576-8405
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Fax | 202-576-8457
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Authorized Official
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Title or Position | CHIEF OF HEALTH SERVICES
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Name | DR. ANDREA WEISMAN
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Credential | PH.D.
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Telephone | 202-576-8139
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QP2400X
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Taxonomy Name | Prison Health Clinic/Center
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License Number | 261QP2400X
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License Number State | DC
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