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NPI Code Detail

MEDICARE: CAPITAL CLUBHOUSE INC.

MEDICARE: CAPITAL CLUBHOUSE 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
1251S00000XCommunity/Behavioral Health Agency
2261QM0801XMental Health Clinic/Center (Including Community Mental Health Center)

General Provider Information

NPI Number : 1356807838
Entity Type Code : Organization
Provider Name (Legal Business Name) : CAPITAL CLUBHOUSE INC.
Provider Business Mailing Address
First Line : 1313 NEW YORK AVE NW FL 1
Second Line :
City : WASHINGTON
State : DC
Zip : 20005-4701
Country : US
Telephone Number : 202-308-9690
Fax Number :
Provider Business Practice Location Address
First Line : 1313 NEW YORK AVE NW FL 1
Second Line :
City : WASHINGTON
State : DC
Zip : 20005-4701
Country : US
Telephone Number : 202-308-9690
Fax Number :
Authorized Official
Title or Position : EXECUTIVE DIRECTOR
Name : MS. MARIA NUNEZ
Credential : LICSW
Telephone Number : 202-308-9690
Provider Enumeration Date : 02/20/2019
Last Update Date : 03/04/2020

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Directions to “CAPITAL CLUBHOUSE INC. ” Practice Location

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