Provider Demographics
NPI:1275800914
Name:COMMUNITY OF HOPE INC.
Entity Type:Organization
Organization Name:COMMUNITY OF HOPE INC.
Other - Org Name:COVENANT
Other - Org Type:Other Name
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MS
Authorized Official - First Name:KELLY
Authorized Official - Middle Name:
Authorized Official - Last Name:SWEENEY MCSHANE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-407-7746
Mailing Address - Street 1:1717 MASSACHUSETTS AVE NW
Mailing Address - Street 2:SUITE 805
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20036-2001
Mailing Address - Country:US
Mailing Address - Phone:202-407-7747
Mailing Address - Fax:
Practice Address - Street 1:3845 S CAPITOL ST SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1419
Practice Address - Country:US
Practice Address - Phone:202-407-7747
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2011-11-23
Last Update Date:2011-11-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QF0400XAmbulatory Health Care FacilitiesClinic/CenterFederally Qualified Health Center (FQHC)
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037409300Medicaid
DCG00910Medicare PIN