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
Other identifiers
Code
Description
Identifier
Issuer
State
05
—
005145400
—
MD
05
—
029833400
—
DC
05
—
09810714
—
VA
Enumeration date
11/29/2011
Last updated
09/06/2016
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