Provider Demographics
NPI:1083035125
Name:CAPITOL HILL SUPPORTIVE SERVICES PROGRAM INC.
Entity Type:Organization
Organization Name:CAPITOL HILL SUPPORTIVE SERVICES PROGRAM INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:TONYA
Authorized Official - Middle Name:
Authorized Official - Last Name:COPPIN
Authorized Official - Suffix:
Authorized Official - Credentials:MSED;MSSP,ED
Authorized Official - Phone:202-543-4212
Mailing Address - Street 1:2052 W VIRGINIA AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20002-1832
Mailing Address - Country:US
Mailing Address - Phone:202-543-4212
Mailing Address - Fax:202-543-0059
Practice Address - Street 1:2052 W VIRGINIA AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002-1832
Practice Address - Country:US
Practice Address - Phone:202-543-4212
Practice Address - Fax:202-543-0059
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-12-16
Last Update Date:2013-12-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC025928400251C00000X, 320600000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251C00000XAgenciesDay Training, Developmentally Disabled Services
No320600000XResidential Treatment FacilitiesResidential Treatment Facility, Intellectual and/or Developmental Disabilities
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC025928400Medicaid