| NPI | 1649601154 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | BOBBI HOWARD Credentialing Lead 202-984-1823 |
| 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) | |
| 251B00000X Case Management | |
| 261Q00000X Clinic/Center | |
| Enumeration Date | 2013-12-09 |
| Last Update Date | 2025-11-07 |