Provider Demographics
NPI:1720285414
Name:PEDIATRIC AIDS HIV CARE INC
Entity Type:Organization
Organization Name:PEDIATRIC AIDS HIV CARE INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MR
Authorized Official - First Name:DEREK
Authorized Official - Middle Name:KELLY
Authorized Official - Last Name:ORR
Authorized Official - Suffix:
Authorized Official - Credentials:MPA
Authorized Official - Phone:202-347-5366
Mailing Address - Street 1:PO BOX 77543
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20013-8543
Mailing Address - Country:US
Mailing Address - Phone:202-347-5366
Mailing Address - Fax:202-621-3082
Practice Address - Street 1:450 M ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4606
Practice Address - Country:US
Practice Address - Phone:202-347-5366
Practice Address - Fax:202-621-3082
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-06-27
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes1041C0700XBehavioral Health & Social Service ProvidersSocial WorkerClinicalGroup - Single Specialty