1134446826 NPI number — WISCONSIN AVENUE PSYCHIATRIC CENTER

Table of content: (NPI 1134446826)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1134446826 NPI number — WISCONSIN AVENUE PSYCHIATRIC CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
WISCONSIN AVENUE PSYCHIATRIC CENTER
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
PSYCHIATRIC INSTITUTE OF WASHINGTON
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1134446826
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/21/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4228 WISCONSIN AVE NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20016-2138
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-885-5600
Provider Business Mailing Address Fax Number:
202-966-7374

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
4228 WISCONSIN AVE NW
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20016-2138
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-885-5600
Provider Business Practice Location Address Fax Number:
202-966-7374
Provider Enumeration Date:
04/21/2010

Additional Information

Authorized Official

Authorized Official Last Name:
BAUMGARDNER
Authorized Official First Name:
CHARLES
Authorized Official Middle Name:
J.
Authorized Official Title or Position:
VP OF CORPORATE OPERATIONS
Authorized Official Telephone Number:
202-885-5679

Provider Taxonomy Codes

  • Taxonomy code: 283Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 292085900 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com