MEDICARE: COMPREHENSIVE CARE II INC

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	320600000X	Intellectual and/or Developmental Disabilities Residential Treatment Facility		DC

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205965746
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	COMPREHENSIVE CARE II INC

Provider Business Mailing Address
First Line	:	1329 LONGFELLOW ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-3517
Country	:	US
Telephone Number	:	301-270-7041
Fax Number	:	301-270-5076

Provider Business Practice Location Address
First Line	:	1329 LONGFELLOW ST NW
Second Line	:
City	:	WASHINGTON
State	:	DC
Zip	:	20011-3517
Country	:	US
Telephone Number	:	202-291-2173
Fax Number	:	202-291-1085

Authorized Official
Title or Position	:	ADMINISTRATOR
Name	:	DR. RODWELL BUCKLEY
Credential	:
Telephone Number	:	301-270-7041

Provider Enumeration Date	:	03/02/2007
Last Update Date	:	09/26/2016

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