Provider Demographics
NPI:1083899454
Name:HOLY COMFORTER-ST. CYPRIAN COMMUNITY ACTION G
Entity Type:Organization
Organization Name:HOLY COMFORTER-ST. CYPRIAN COMMUNITY ACTION G
Other - Org Name:ADULT RESIDENTIAL MEN COMPONENT
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MS
Authorized Official - First Name:JANICE
Authorized Official - Middle Name:M
Authorized Official - Last Name:DESSASO
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-543-4558
Mailing Address - Street 1:335 8TH STREET, SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003
Mailing Address - Country:US
Mailing Address - Phone:202-543-4558
Mailing Address - Fax:202-543-4579
Practice Address - Street 1:#16 17TH STREET, NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20002
Practice Address - Country:US
Practice Address - Phone:202-388-9182
Practice Address - Fax:202-388-4052
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY COMPORTER-ST. CYPRIAN COMMUNITY ACTION GROUP
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2008-01-04
Last Update Date:2012-07-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC037114400324500000X
DC102500RM-023324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility