Provider Demographics
NPI:1871995126
Name:NATIONAL CAPITAL TREATMENT AND RECOVERY
Entity type:Organization
Organization Name:NATIONAL CAPITAL TREATMENT AND RECOVERY
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:DIRECTOR OF REVENUE CYCLE
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:
Authorized Official - Last Name:NICHOLAS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:703-825-8762
Mailing Address - Street 1:200 N GLEBE RD
Mailing Address - Street 2:SUITE 104
Mailing Address - City:ARLINGTON
Mailing Address - State:VA
Mailing Address - Zip Code:22203-3728
Mailing Address - Country:US
Mailing Address - Phone:703-841-0703
Mailing Address - Fax:703-243-0975
Practice Address - Street 1:4317 6TH ST S
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22204-1411
Practice Address - Country:US
Practice Address - Phone:703-841-0703
Practice Address - Fax:703-243-0975
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:NATIONAL CAPITAL TREATMENT AND RECOVERY
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2014-09-18
Last Update Date:2022-04-20
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA122-01-007324500000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes324500000XResidential Treatment FacilitiesSubstance Abuse Rehabilitation Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA12201043Medicaid
VA1558415968OtherNPI
VA1558415968OtherNPI