Provider Demographics
NPI:1508041880
Name:HOLY COMFORTER-ST. CYPRIAN COMMUNITY ACTION G
Entity Type:Organization
Organization Name:HOLY COMFORTER-ST. CYPRIAN COMMUNITY ACTION G
Other - Org Name:ADULT WOMEN RESIDENTIAL TREATMENT
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 1:3321 13TH STREET, SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032
Practice Address - Country:US
Practice Address - Phone:202-373-0940
Practice Address - Fax:202-373-0818
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:HOLY COMFORTER-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
DC037112800324500000X
DC102500RW-023324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility