Provider Demographics
NPI:1548430226
Name:FEDERAL CITY RECOVERY SERVICES
Entity Type:Organization
Organization Name:FEDERAL CITY RECOVERY SERVICES
Other - Org Name:FEDERAL CITY RECOVERY ATLANTIC
Other - Org Type:Other Name
Authorized Official - Title/Position:CEO
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 54790
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-9390
Mailing Address - Country:US
Mailing Address - Phone:202-236-4362
Mailing Address - Fax:202-562-5602
Practice Address - Street 1:200 ATLANTIC ST SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-3040
Practice Address - Country:US
Practice Address - Phone:202-236-4362
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-03-10
Last Update Date:2021-04-15
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC102500R007261QR0405X
3245S0500X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
No3245S0500XResidential Treatment FacilitiesSubstance Abuse Rehabilitation FacilitySubstance Abuse Treatment, Children
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC041280200Medicaid