Provider Demographics
NPI:1427488014
Name:ETHOS FOUNDATION INCORPORATED
Entity type:Organization
Organization Name:ETHOS FOUNDATION INCORPORATED
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT
Authorized Official - Prefix:DR
Authorized Official - First Name:PHILIP
Authorized Official - Middle Name:IGNATIUS
Authorized Official - Last Name:BRENNAN
Authorized Official - Suffix:
Authorized Official - Credentials:PHD
Authorized Official - Phone:703-535-6800
Mailing Address - Street 1:312 S WASHINGTON ST
Mailing Address - Street 2:3A
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22314-3684
Mailing Address - Country:US
Mailing Address - Phone:703-535-6800
Mailing Address - Fax:703-535-6999
Practice Address - Street 1:312 S WASHINGTON ST
Practice Address - Street 2:3A
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22314-3684
Practice Address - Country:US
Practice Address - Phone:703-535-6800
Practice Address - Fax:703-535-6999
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2013-11-18
Last Update Date:2013-11-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA145261Q00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes261Q00000XAmbulatory Health Care FacilitiesClinic/Center