Provider Demographics
NPI:1710040720
Name:WILLIAM WENDT CENTER FOR LOSS AND HEALING
Entity Type:Organization
Organization Name:WILLIAM WENDT CENTER FOR LOSS AND HEALING
Other - Org Name:ST FRANCIS CENTER
Other - Org Type:Former Legal Business Name
Authorized Official - Title/Position:DIRECTOR OF CLINICAL SERVICES
Authorized Official - Prefix:
Authorized Official - First Name:JERRI
Authorized Official - Middle Name:L
Authorized Official - Last Name:ANGLIN
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:202-422-8063
Mailing Address - Street 1:4201 CONNECTICUT AVENUE NW
Mailing Address - Street 2:SUITE 300
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20008-1162
Mailing Address - Country:US
Mailing Address - Phone:202-624-0010
Mailing Address - Fax:202-624-0062
Practice Address - Street 1:4201 CONNECTICUT AVENUE NW
Practice Address - Street 2:SUITE 300
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20008-1162
Practice Address - Country:US
Practice Address - Phone:202-624-0010
Practice Address - Fax:202-624-0062
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2020-07-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes261QM0801XAmbulatory Health Care FacilitiesClinic/CenterMental Health (Including Community Mental Health Center)Group - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC037516200Medicaid
DC037516200Medicaid
DC009262S34Medicare ID - Type Unspecified