Healthcare Provider Details

I. General information

NPI: 1427100502
Provider Name (Legal Business Name): GREATER SOUTHEAST COMMUNITY HOSPITAL CORP I
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/17/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SOUTHERN AVE SE
WASHINGTON DC
20032-4623
US

IV. Provider business mailing address

1310 SOUTHERN AVE SE
WASHINGTON DC
20032-4623
US

V. Phone/Fax

Practice location:
  • Phone: 202-574-6000
  • Fax: 202-279-7412
Mailing address:
  • Phone: 202-574-6000
  • Fax: 202-279-7412

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code273Y00000X
TaxonomyRehabilitation Hospital Unit
License NumberHFD01-0198
License Number StateDC

VIII. Authorized Official

Name: MR. PAUL R. TUFT
Title or Position: PRESIDENT
Credential:
Phone: 480-348-1099