Healthcare Provider Details

I. General information

NPI: 1851729529
Provider Name (Legal Business Name): 2905 ALF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2013
Last Update Date: 10/16/2013
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2905 11TH ST NW
WASHINGTON DC
20001-3903
US

IV. Provider business mailing address

2905 11TH ST NW
WASHINGTON DC
20001-3903
US

V. Phone/Fax

Practice location:
  • Phone: 202-671-6553
  • Fax:
Mailing address:
  • Phone: 202-671-6553
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State

VIII. Authorized Official

Name: STEPHEN M GREEN
Title or Position: DIRECTOR
Credential:
Phone: 202-535-1024