1114389533 NPI number — CAPITOL HILL COMMUNITY HEALTH CENTER

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1114389533 NPI number — CAPITOL HILL COMMUNITY HEALTH CENTER

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITOL HILL COMMUNITY HEALTH 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:
Provider Other Organization Name Type Code:
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:
1114389533
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/24/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
201 8TH ST NE
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:
20002-6153
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-546-7696
Provider Business Mailing Address Fax Number:
202-546-8050

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1930 MARTIN LUTHER KING JR AVE SE
Provider Second Line Business Practice Location Address:
1ST FLOOR
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20020-7006
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-678-6554
Provider Business Practice Location Address Fax Number:
202-678-1305
Provider Enumeration Date:
03/24/2016

Additional Information

Authorized Official

Authorized Official Last Name:
VAN COOTEN
Authorized Official First Name:
ALLISON
Authorized Official Middle Name:
A.
Authorized Official Title or Position:
CHIEF EXECUTIVE OFFICER
Authorized Official Telephone Number:
202-546-7696

Provider Taxonomy Codes

  • Taxonomy code: 261QP2300X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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