Healthcare Provider Details

I. General information

NPI: 1396103891
Provider Name (Legal Business Name): STODDARD ADULT DAY CARE CENTER LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2016
Last Update Date: 01/29/2016
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2112 VARNUM ST NE
WASHINGTON DC
20018-3320
US

IV. Provider business mailing address

1818 NEWTON ST NW
WASHINGTON DC
20010-1017
US

V. Phone/Fax

Practice location:
  • Phone: 202-541-6153
  • Fax:
Mailing address:
  • Phone: 202-328-7400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code311ZA0620X
TaxonomyAdult Care Home Facility
License Number
License Number State

VIII. Authorized Official

Name: STEVEN NASH
Title or Position: CEO
Credential:
Phone: 202-328-7400