| NPI | 1184616617 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | FELICIA DAVIS Credentialing 202-797-4428 |
| Organization Subpart ? | Yes |
| Primary Taxonomy | 261QF0400X Clinic/Center Federally Qualified Health Center (FQHC) |
| Additional Taxonomies | 261QC1500X Clinic/Center Community Health (Licence: DC MD33659) |
| 261Q00000X Clinic/Center | |
| 261QC1500X Clinic/Center Community Health | |
| 261QD0000X Clinic/Center Dental | |
| 261QM0801X Clinic/Center Mental Health (Including Community Mental Health Center) | |
| 261QM0850X Clinic/Center Adult Mental Health | |
| Enumeration Date | 2005-08-19 |
| Last Update Date | 2024-03-19 |