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Organization
PHS BEHAVIORAL MEDICINE
Active
Organization
PHS BEHAVIORAL MEDICINE
Active
Parent organization
PROVIDENCE HOSPITAL
Other names
Providence Health Services
Organization subpart
Yes
Provider details
NPI number
Legal business name
PROVIDENCE HOSPITAL
Authorized official
MR. CHARLES F HABERKERN (VP)
(202) 854-4255
Entity
Organization
Contact information
Practice address
1053 BUCHANAN ST NE, SUITE 055, WASHINGTON, DC 20017-2712
(202) 269-7626
(202) 269-7616
Mailing address
1150 VARNUM ST NE, ST CATHERINE'S HALL, ROOM 102, WASHINGTON, DC 20017-2104
(202) 854-4069
(202) 854-7825
Taxonomy
Speciality
Code
Description
License number
State
2084A0401X
Addiction Medicine (Psychiatry & Neurology) Physician
Primary
HFD01-0212
DC
2084N0400X
Neurology Physician
HFD01-0212
DC
282N00000X
General Acute Care Hospital
HFD01-0112
DC
Other
Enumeration date
11/29/2011
Last updated
09/06/2016
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