1235525692 NPI number — ANDROMEDA TRANSCULTURAL HEALTH

Table of content: (NPI 1235525692)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1235525692 NPI number — ANDROMEDA TRANSCULTURAL HEALTH

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
ANDROMEDA TRANSCULTURAL HEALTH
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:
ANDROMEDA TRANSCULTURAL HEALTH
Provider Other Organization Name Type Code:
4
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:
1235525692
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/08/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
1400 DECATUR ST 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:
20011-4343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-291-4707
Provider Business Mailing Address Fax Number:
202-723-4560

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1400 DECATUR ST 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:
20011-4343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-291-4707
Provider Business Practice Location Address Fax Number:
202-723-4560
Provider Enumeration Date:
04/13/2015

Additional Information

Authorized Official

Authorized Official Last Name:
GUZMAN
Authorized Official First Name:
ALVARO
Authorized Official Middle Name:
Authorized Official Title or Position:
INTERIM EXECUTIVE DIRECTOR
Authorized Official Telephone Number:
202-291-4707

Provider Taxonomy Codes

  • Taxonomy code: 207Q00000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .
  • Taxonomy code: 261QC1500X , with the licence number: PH100000948 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .
  • Taxonomy code: 261QC1500X , with the licence number: 0202209782 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "N" .

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

  • Identifier: 1568634590 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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