Provider Demographics
NPI:1639671910
Name:MY BROTHER'S KEEPER TRANSITIONAL LIVING SERVICES, LLC
Entity Type:Organization
Organization Name:MY BROTHER'S KEEPER TRANSITIONAL LIVING SERVICES, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR
Authorized Official - Prefix:
Authorized Official - First Name:EBONY
Authorized Official - Middle Name:
Authorized Official - Last Name:WASHINGTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-386-6311
Mailing Address - Street 1:1390 KENYON ST NW APT 614
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-7227
Mailing Address - Country:US
Mailing Address - Phone:202-246-5568
Mailing Address - Fax:
Practice Address - Street 1:1390 KENYON ST NW APT 614
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-7227
Practice Address - Country:US
Practice Address - Phone:202-246-5568
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2018-03-02
Last Update Date:2018-03-02
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)