| NPI | 1174011563 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | MARANGELY NAZARIO Credentialing Manager 202-420-7175 |
| 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 | 2018-05-01 |
| Last Update Date | 2018-11-14 |