Provider Demographics
NPI:1831265131
Name:PSYCHIATRIC CENTER CHARTERED,INC
Entity type:Organization
Organization Name:PSYCHIATRIC CENTER CHARTERED,INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHIEF EXECUTIVE OFFICER
Authorized Official - Prefix:MRS
Authorized Official - First Name:ELLIRE
Authorized Official - Middle Name:
Authorized Official - Last Name:HALL
Authorized Official - Suffix:
Authorized Official - Credentials:LICSW
Authorized Official - Phone:202-635-3577
Mailing Address - Street 1:PO BOX 41368
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20018-0768
Mailing Address - Country:US
Mailing Address - Phone:202-635-3577
Mailing Address - Fax:202-635-0906
Practice Address - Street 1:3001 BLADENSBURG RD NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-2235
Practice Address - Country:US
Practice Address - Phone:202-635-3577
Practice Address - Fax:202-635-0906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-11-28
Last Update Date:2020-08-22
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes2084P0800XAllopathic & Osteopathic PhysiciansPsychiatry & NeurologyPsychiatryGroup - Single Specialty
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC6416OtherCAREFIRST- OUTPATIENT
DCGZ3-015OtherCAREFIRST - DAY SERVICES
DC6416OtherCAREFIRST- OUTPATIENT