Provider Demographics
NPI:1134499635
Name:AQUILA RECOVERY CHARTERED
Entity Type:Organization
Organization Name:AQUILA RECOVERY CHARTERED
Other - Org Name:AQUILA RECOVERY
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT AND PRACTICE MANAGER
Authorized Official - Prefix:MR
Authorized Official - First Name:ROBERT
Authorized Official - Middle Name:R
Authorized Official - Last Name:COFFEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-244-0962
Mailing Address - Street 1:4455 CONNECTICUT AVE NW
Mailing Address - Street 2:SUITE 350
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-2324
Mailing Address - Country:US
Mailing Address - Phone:202-244-0962
Mailing Address - Fax:
Practice Address - Street 1:4455 CONNECTICUT AVE NW
Practice Address - Street 2:SUITE 350
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-2324
Practice Address - Country:US
Practice Address - Phone:202-244-0962
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-12-31
Last Update Date:2011-12-31
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC110211A-225261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center