Provider Demographics
NPI:1184955759
Name:GOSPEL RESCUE MINISTRIES OF WASHINGTON, DC, INC.
Entity type:Organization
Organization Name:GOSPEL RESCUE MINISTRIES OF WASHINGTON, DC, INC.
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR AND PRESIDENT
Authorized Official - Prefix:MR
Authorized Official - First Name:MICHAEL
Authorized Official - Middle Name:J
Authorized Official - Last Name:CORTESE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-842-1731
Mailing Address - Street 1:810 5TH ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-2622
Mailing Address - Country:US
Mailing Address - Phone:202-842-1731
Mailing Address - Fax:202-898-0285
Practice Address - Street 1:810 5TH ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-2622
Practice Address - Country:US
Practice Address - Phone:202-842-1731
Practice Address - Fax:202-898-0285
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2010-01-21
Last Update Date:2010-02-24
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC091709A-205261QR0405X
DC012301RW-116324500000X
DC012201R-098324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
No261QR0405XAmbulatory Health Care FacilitiesClinic/CenterRehabilitation, Substance Use Disorder
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC039475700Medicaid