| NPI | 1124309984 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | VINCENT KEANE President/Chief Executive Office 202-715-6562 |
| Organization Subpart ? | No |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QD0000X Clinic/Center Dental |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| Enumeration Date | 2011-09-07 |
| Last Update Date | 2020-05-13 |