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1310 Southern Ave Se Washington DC 20032-4623 | |
| (202) 574-6611 | |
| (202) 574-7188 |
| Full Name | |
|---|---|
| Speciality | Psychiatric Unit |
| Location | 1310 Southern Ave Se, Washington, District Of Columbia |
| Authorized Official Name and Position | Frank G. Delisi (CHIEF EXECUTIVE OFFICER) |
| Authorized Official Contact | 2025746611 |
| Accepts Medicare Insurance | This clinic does not participate in Medicare Program. |
| Mailing Address | Practice Location Address |
|---|---|
1310 Southern Ave Se Washington DC 20032-4623 Ph: (202) 574-6611 | 1310 Southern Ave Se Washington DC 20032-4623 Ph: (202) 574-6611 |
| NPI Number | 1174836761 |
|---|---|
| Provider Enumeration Date | 07/23/2010 |
| Last Update Date | 07/23/2010 |
| Identifier | Type | State | Issuer |
|---|---|---|---|
| 1174836761 | NPI | - | NPPES |
| Taxonomy | Type | License (State) | Status |
|---|---|---|---|
| 273R00000X | Psychiatric Unit | (* (Not Available)) | Primary |
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