Basic Information
Provider Information | |||||||||
NPI: | 1881970465 | ||||||||
EntityType: | 2 | ||||||||
ReplacementNPI: |   | ||||||||
OrganizationName: | COMMUNITY OF HOPE | ||||||||
LastName: |   | ||||||||
FirstName: |   | ||||||||
MiddleName: |   | ||||||||
NamePrefix: |   | ||||||||
NameSuffix: |   | ||||||||
Credential: |   | ||||||||
OtherOrganizationName: | FAMILY HEALTH AND BIRTH CENTER - FACILITY | ||||||||
OtherOrganizationType: | 5 | ||||||||
OtherLastName: |   | ||||||||
OtherFirstName: |   | ||||||||
OtherMiddleName: |   | ||||||||
OtherNamePrefix: |   | ||||||||
OtherNameSuffix: |   | ||||||||
OtherCredential: |   | ||||||||
OtherLastNameType: |   | ||||||||
Mailing Information | |||||||||
Address1: | 4 ATLANTIC ST SW | ||||||||
Address2: |   | ||||||||
City: | WASHINGTON | ||||||||
State: | DC | ||||||||
PostalCode: | 200322350 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2024077747 | ||||||||
FaxNumber: | 2022321014 | ||||||||
Practice Location | |||||||||
Address1: | 2120 BLADENSBURG RD NE | ||||||||
Address2: |   | ||||||||
City: | WASHINGTON | ||||||||
State: | DC | ||||||||
PostalCode: | 200181440 | ||||||||
CountryCode: | US | ||||||||
TelephoneNumber: | 2025409857 | ||||||||
FaxNumber: | 2022328494 | ||||||||
Other Information | |||||||||
ProviderEnumerationDate: | 10/27/2011 | ||||||||
LastUpdateDate: | 11/02/2022 | ||||||||
NPIDeactivationReasonCode: |   | ||||||||
NPIDeactivationDate: |   | ||||||||
NPIReactivationDate: |   | ||||||||
ProviderGenderCode: |   | ||||||||
AuthorizedOfficialLastName: | SYKES | ||||||||
AuthorizedOfficialFirstName: | DEREK | ||||||||
AuthorizedOfficialMiddleName: |   | ||||||||
AuthorizedOfficialTitleorPosition: | VP OF FINANCE AND OPERATIONS | ||||||||
AuthorizedOfficialTelephone: | 2024077747 | ||||||||
IsSoleProprietor: |   | ||||||||
IsOrganizationSubpart: | N | ||||||||
ParentOrganizationLBN: |   | ||||||||
AuthorizedOfficialNamePrefix: | MR. | ||||||||
AuthorizedOfficialNameSuffix: |   | ||||||||
AuthorizedOfficialCredential: |   | ||||||||
NPICertificationDate: | 11/02/2022 |
Taxonomy Information
Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 261QB0400X |   |   | Y |   | Ambulatory Health Care Facilities | Clinic/Center | Birthing |
ID Information
ID | Type | State | Issuer | Description | 037409300 | 05 | DC |   | MEDICAID |