1346463098 NPI number — COMPREHENSIVE CARE II INC

Table of content: SHIVANI JAIN MPHIL, MSC (NPI 1710716642)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1346463098 NPI number — COMPREHENSIVE CARE II INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COMPREHENSIVE CARE II INC
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:
1346463098
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/26/2016
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
PO BOX 60583
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:
20039-0583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-270-7041
Provider Business Mailing Address Fax Number:
301-270-5076

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
1321 EMERSON 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:
20011-6905
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-270-7041
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
04/11/2007

Additional Information

Authorized Official

Authorized Official Last Name:
BUCKLEY
Authorized Official First Name:
RODWELL
Authorized Official Middle Name:
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
301-270-7041

Provider Taxonomy Codes

  • Taxonomy code: 320600000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 024073400 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".




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