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General NPI Number Information
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NPI Number | 1336301407
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Entity Type | Organization
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Legal Business Name | COMMUNITY ACTION GROUP
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Dates
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Enumeration Date | 06/30/2008
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Last Update Date | 06/30/2008
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Provider Practice Location Address
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Address Line | 3325 13TH ST SE
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City | WASHINGTON
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State | DC
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Zip | 20032-4533
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Country | US
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Telephone | 202-373-0656
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Fax | 202-373-0665
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Provider Business Mailing Address
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Address Line | 3323 13TH ST., S.E.
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City | WASHINGTON
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State | DC
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Zip | 20032
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Country | US
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Telephone | 202-373-0650
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. HAROLD GORDON
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Credential |
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Telephone | 202-543-4558
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QM0850X
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Taxonomy Name | Adult Mental Health Clinic/Center
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License Number |
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License Number State |
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