1881970465 NPI number — COMMUNITY OF HOPE

Table of content: CAL HUIZENGA MSE CADC III (NPI 1083624449)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1881970465 NPI number — COMMUNITY OF HOPE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMMUNITY OF HOPE
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:
FAMILY HEALTH AND BIRTH CENTER - FACILITY
Provider Other Organization Name Type Code:
5
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:
1881970465
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/02/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
4 ATLANTIC ST SW
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:
20032-2350
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-407-7747
Provider Business Mailing Address Fax Number:
202-232-1014

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
2120 BLADENSBURG RD NE
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:
20018-1440
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-540-9857
Provider Business Practice Location Address Fax Number:
202-232-8494
Provider Enumeration Date:
10/27/2011

Additional Information

Authorized Official

Authorized Official Last Name:
SYKES
Authorized Official First Name:
DEREK
Authorized Official Middle Name:
Authorized Official Title or Position:
VP OF FINANCE AND OPERATIONS
Authorized Official Telephone Number:
202-407-7747

Provider Taxonomy Codes

  • Taxonomy code: 261QB0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 037409300 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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