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7826 Eastern Ave, N.w. Suite Ll14 Washington DC 20012-4617 | |
| (202) 722-1700 | |
| (202) 722-1777 |
| Full Name | |
|---|---|
| Speciality | Community/Behavioral Health |
| Location | 7826 Eastern Ave, N.w. Suite Ll14, Washington, District Of Columbia |
| Authorized Official Name and Position | Michel Alain Kahak (PRESIDENT) |
| Authorized Official Contact | 3016411514 |
| Accepts Medicare Insurance | Yes. This clinic participates in medicare program and accept medicare insurance. |
| Mailing Address | Practice Location Address |
|---|---|
7826 Eastern Ave, N.w. Suite Ll14 Washington DC 20012-4617 Ph: () - | 7826 Eastern Ave, N.w. Suite Ll14 Washington DC 20012-4617 Ph: (202) 722-1700 |
| NPI Number | 1568638187 |
|---|---|
| Provider Enumeration Date | 05/03/2008 |
| Last Update Date | 01/07/2025 |
| Certification Date | 01/07/2025 |
| Medicare PECOS PAC ID | 6608299037 |
|---|---|
| Medicare Enrollment ID | O20240608000158 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1568638187 | NPI | - | NPPES |
| Provider Name | Bruce B Tisdale |
|---|---|
| Provider Type | Practitioner - Clinical Social Worker |
| Provider Identifiers | NPI Number: 1588816490 PECOS PAC ID: 7315104965 Enrollment ID: I20120209000108 |
| Provider Name | Tony A Gore |
|---|---|
| Provider Type | Practitioner - Psychiatry |
| Provider Identifiers | NPI Number: 1780766881 PECOS PAC ID: 7012264575 Enrollment ID: I20180716002326 |
| Provider Name | Babatunde Olusegun Akinyemi |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1992204937 PECOS PAC ID: 4082049267 Enrollment ID: I20200214000268 |
| Provider Name | Wilson Onwuasonya |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1750784922 PECOS PAC ID: 9537535760 Enrollment ID: I20221013000652 |
| Provider Name | Oluyemisi Olanike Awe |
|---|---|
| Provider Type | Practitioner - Nurse Practitioner |
| Provider Identifiers | NPI Number: 1316623036 PECOS PAC ID: 0941659585 Enrollment ID: I20231208000447 |
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