Provider Demographics
NPI:1821273111
Name:HOLY COMFORTER-ST. CYPRIAN COMMUNITY ACTION GROUP
Entity Type:Organization
Organization Name:HOLY COMFORTER-ST. CYPRIAN COMMUNITY ACTION GROUP
Other - Org Name:OUTPATIENT TREATMENT PROGRAM
Other - Org Type:Other Name
Authorized Official - Title/Position:PRESIDENT/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:HAROLD
Authorized Official - Middle Name:J
Authorized Official - Last Name:GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-543-4558
Mailing Address - Street 1:901 PENNSYLVANIA AVE SE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20003-2141
Mailing Address - Country:US
Mailing Address - Phone:202-543-4558
Mailing Address - Fax:202-543-4579
Practice Address - Street 1:1238 PENNSYLVANIA AVE SE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20003-2226
Practice Address - Country:US
Practice Address - Phone:202-543-4750
Practice Address - Fax:202-543-4754
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-01-04
Last Update Date:2008-01-04
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility