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General NPI Number Information
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NPI Number | 1508111717
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Entity Type | Organization
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Legal Business Name | TREATMENT 1
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Dates
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Enumeration Date | 07/13/2012
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Last Update Date | 07/13/2012
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Provider Practice Location Address
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Address Line | 2431 25TH ST SE APT 1
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City | WASHINGTON
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State | DC
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Zip | 20020-3467
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Country | US
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Telephone | 202-390-8043
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Fax |
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Provider Business Mailing Address
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Address Line | 2431 25TH ST SE APT 1
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City | WASHINGTON
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State | DC
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Zip | 20020-3467
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Country | US
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Telephone | 202-390-8043
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Fax |
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Authorized Official
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Title or Position | LABORER
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Name | MR. KALEB CARTER
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Credential | SR.
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Telephone | 202-486-9954
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 171W00000X
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Taxonomy Name | Contractor
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License Number | 96890253100000X
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License Number State | DC
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