Provider Demographics
NPI:1104095991
Name:PEDIATRIC AIDS HIV CARE
Entity type:Organization
Organization Name:PEDIATRIC AIDS HIV CARE
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:EXECUTIVE DIRECTOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:KHADIJAH
Authorized Official - Middle Name:A
Authorized Official - Last Name:TRIBBLE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-347-5366
Mailing Address - Street 1:450 M ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20001-4606
Mailing Address - Country:US
Mailing Address - Phone:202-347-5366
Mailing Address - Fax:202-628-3021
Practice Address - Street 1:450 M ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20001-4606
Practice Address - Country:US
Practice Address - Phone:202-347-5366
Practice Address - Fax:202-628-3021
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-02-26
Last Update Date:2008-02-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecializationGroup
Yes101YM0800XBehavioral Health & Social Service ProvidersCounselorMental HealthGroup - Single Specialty
No102X00000XBehavioral Health & Social Service ProvidersPoetry TherapistGroup - Single Specialty
No171M00000XOther Service ProvidersCase Manager/Care CoordinatorGroup - Single Specialty
No251B00000XAgenciesCase ManagementGroup - Single Specialty
No251S00000XAgenciesCommunity/Behavioral HealthGroup - Single Specialty
No343900000XTransportation ServicesNon-emergency Medical Transport (VAN)Group - Single Specialty