MEDICARE: CN SBHC NORTHWESTERN HS

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	261QD0000X	Dental Clinic/Center
2	261QS1000X	Student Health Clinic/Center

General Provider Information

NPI Number	:	1114884129
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CN SBHC NORTHWESTERN HS

Provider Business Mailing Address
First Line	:	111 MICHIGAN AVE NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20010-2916
Country	:	US
Telephone Number	:
Fax Number	:

Provider Business Practice Location Address
First Line	:	7000 ADELPHI RD
Second Line	:
City	:	HYATTSVILLE
State	:	MD
Zip	:	20782-1454
Country	:	US
Telephone Number	:	301-749-4722
Fax Number	:

Authorized Official
Title or Position	:	VP PAYOR FINANCIAL RELATIONS
Name	:	PHILLICIA NELSON
Credential	:
Telephone Number	:	301-572-6281

Provider Enumeration Date	:	01/09/2026
Last Update Date	:	01/09/2026

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