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General NPI Number Information
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NPI Number | 1245951276
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Entity Type | Organization
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Legal Business Name | GENERATIONAL HEALTH COMMUNITY CLINIC
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Dates
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Enumeration Date | 09/07/2022
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Last Update Date | 09/07/2022
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Provider Practice Location Address
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Address Line | 617 RHODE ISLAND AVE NE STE D
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City | WASHINGTON
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State | DC
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Zip | 20002-1299
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Country | US
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Telephone | 202-486-1152
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Fax |
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Provider Business Mailing Address
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Address Line | 617 RHODE ISLAND AVE NE STE D
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City | WASHINGTON
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State | DC
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Zip | 20002-1299
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Country | US
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Telephone | 202-486-1152
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Fax |
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Authorized Official
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Title or Position | WOUND CARE ASSOCIATE
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Name | MS. KIMBERLY M BURRIS
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Credential | WCA
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Telephone | 202-486-1152
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QC1500X
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Taxonomy Name | Community Health Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 251S00000X
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Taxonomy Name | Community/Behavioral Health Agency
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License Number |
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License Number State |
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