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General NPI Number Information
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NPI Number | 1427488014
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Entity Type | Organization
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Legal Business Name | ETHOS FOUNDATION INCORPORATED
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Dates
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Enumeration Date | 11/18/2013
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Last Update Date | 11/18/2013
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Provider Practice Location Address
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Address Line | 312 S WASHINGTON ST 3A
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3684
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Country | US
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Telephone | 703-535-6800
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Fax | 703-535-6999
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Provider Business Mailing Address
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Address Line | 312 S WASHINGTON ST 3A
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City | ALEXANDRIA
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State | VA
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Zip | 22314-3684
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Country | US
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Telephone | 703-535-6800
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Fax | 703-535-6999
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Authorized Official
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Title or Position | PRESIDENT
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Name | DR. PHILIP IGNATIUS BRENNAN
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Credential | PH.D.
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Telephone | 703-535-6800
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261Q00000X
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Taxonomy Name | Clinic/Center
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License Number | 145
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License Number State | VA
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