Basic Information
| Provider Information | |||||||||
| NPI: | 1730681420 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | COMMUNITY OF HOPE INC. | ||||||||
| LastName: | |||||||||
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| OtherOrganizationName: | THE COMMONS AT STANTON SQUARE | ||||||||
| OtherOrganizationType: | 5 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 4 ATLANTIC ST SW | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 200322350 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024077747 | ||||||||
| FaxNumber: | 2022328494 | ||||||||
| Practice Location | |||||||||
| Address1: | 2375 ELVANS ROAD SE | ||||||||
| Address2: | |||||||||
| City: | WASHINGTON | ||||||||
| State: | DC | ||||||||
| PostalCode: | 20020 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 2024077747 | ||||||||
| FaxNumber: | 2022328494 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 03/08/2018 | ||||||||
| LastUpdateDate: | 02/17/2022 | ||||||||
| NPIDeactivationReasonCode: | |||||||||
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| ProviderGenderCode: | |||||||||
| AuthorizedOfficialLastName: | SYKES | ||||||||
| AuthorizedOfficialFirstName: | DEREK | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | VP OF FINANCE AND OPERATIONS | ||||||||
| AuthorizedOfficialTelephone: | 2024077747 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | MR. | ||||||||
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| AuthorizedOfficialCredential: | |||||||||
| NPICertificationDate: | 02/17/2022 | ||||||||
Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QF0400X | N | Ambulatory Health Care Facilities | Clinic/Center | Federally Qualified Health Center (FQHC) | 261QM0801X | N | Ambulatory Health Care Facilities | Clinic/Center | Mental Health (Including Community Mental Health Center) | 251B00000X | Y | Agencies | Case Management |
No ID Information.