MEDICARE: NATIONAL CAPITAL TREATMENT AND RECOVERY

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	324500000X	Substance Abuse Rehabilitation Facility

General Provider Information

NPI Number	:	1750017141
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	NATIONAL CAPITAL TREATMENT AND RECOVERY

Provider Business Mailing Address
First Line	:	200 N GLEBE RD STE 104
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22203-3755
Country	:	US
Telephone Number	:	703-841-0703
Fax Number	:	703-243-0975

Provider Business Practice Location Address
First Line	:	1554 COLUMBIA PIKE
Second Line	:
City	:	ARLINGTON
State	:	VA
Zip	:	22204-4667
Country	:	US
Telephone Number	:	703-841-0703
Fax Number	:

Authorized Official
Title or Position	:	REVENUE CYCLE DIRECTOR
Name	:	DAVID NICHOLAS
Credential	:
Telephone Number	:	703-825-8762

Provider Enumeration Date	:	07/27/2022
Last Update Date	:	07/27/2022

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