Provider Demographics
NPI:1215811906
Name:THE BOARD OF DIRECTORS AND MANAGERS OF THE MOMENTUM HEALTH DEVELOPMENT
Entity type:Organization
Organization Name:THE BOARD OF DIRECTORS AND MANAGERS OF THE MOMENTUM HEALTH DEVELOPMENT
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CHAIRMAN OF THE BOARD/CEO
Authorized Official - Prefix:MR
Authorized Official - First Name:SHANWLUS
Authorized Official - Middle Name:N
Authorized Official - Last Name:NESBIT
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-666-8658
Mailing Address - Street 1:1802 BELMONT RD NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20009-5162
Mailing Address - Country:US
Mailing Address - Phone:202-655-7501
Mailing Address - Fax:
Practice Address - Street 1:1309 5TH STREET
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20009
Practice Address - Country:US
Practice Address - Phone:202-655-7501
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2025-08-05
Last Update Date:2025-08-05
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251S00000XAgenciesCommunity/Behavioral Health