Provider Demographics
NPI:1427228105
Name:CLEAN AND SOBER STREETS
Entity Type:Organization
Organization Name:CLEAN AND SOBER STREETS
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:HENRY
Authorized Official - Middle Name:PRIMES
Authorized Official - Last Name:PIERCE
Authorized Official - Suffix:III
Authorized Official - Credentials:
Authorized Official - Phone:202-236-4362
Mailing Address - Street 1:PO BOX 77281
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20013-8281
Mailing Address - Country:US
Mailing Address - Phone:202-236-4362
Mailing Address - Fax:
Practice Address - Street 1:425 2ND ST NW
Practice Address - Street 2:2 NORTH
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2003
Practice Address - Country:US
Practice Address - Phone:202-783-7343
Practice Address - Fax:202-628-1183
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2022-05-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC102500R008261QR0405X
324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC111215-263OtherDC CERTIFICATION