Provider Demographics
NPI:1518165760
Name:DEPARTMENT OF BEHAVIORAL HEALTH - ST ELIZABETHS HOSPITAL
Entity Type:Organization
Organization Name:DEPARTMENT OF BEHAVIORAL HEALTH - ST ELIZABETHS HOSPITAL
Other - Org Name:DEPARTMENT OF BEHAVIORAL HEALTH - ST ELIZABETHS HOSPITAL
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:CHIEF OPERATING OFFICER
Authorized Official - Prefix:
Authorized Official - First Name:ANTHEA
Authorized Official - Middle Name:
Authorized Official - Last Name:SEYMOUR
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-299-5150
Mailing Address - Street 1:1100 ALABAMA AVENUE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4540
Mailing Address - Country:US
Mailing Address - Phone:202-299-5500
Mailing Address - Fax:202-645-9983
Practice Address - Street 1:1100 ALABAMA AVENUE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4540
Practice Address - Country:US
Practice Address - Phone:202-299-5500
Practice Address - Fax:202-645-9983
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-07-10
Last Update Date:2014-03-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHFD01-0230283Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes283Q00000XHospitalsPsychiatric Hospital
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC029868300Medicaid
DC029868300Medicaid