Provider Demographics
NPI:1508111717
Name:TREATMENT 1
Entity Type:Organization
Organization Name:TREATMENT 1
Other - Org Name:TREATMENT 1
Other - Org Type:Doing Business As
Authorized Official - Title/Position:LABORER
Authorized Official - Prefix:MR
Authorized Official - First Name:KALEB
Authorized Official - Middle Name:
Authorized Official - Last Name:CARTER
Authorized Official - Suffix:
Authorized Official - Credentials:SR
Authorized Official - Phone:202-486-9954
Mailing Address - Street 1:2431 25TH ST SE APT 1
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20020-3467
Mailing Address - Country:US
Mailing Address - Phone:202-390-8043
Mailing Address - Fax:
Practice Address - Street 1:2431 25TH ST SE APT 1
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20020-3467
Practice Address - Country:US
Practice Address - Phone:202-390-8043
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2012-07-13
Last Update Date:2012-07-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC96890253100000X171W00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes171W00000XOther Service ProvidersContractorGroup - Single Specialty