Healthcare Provider Details

I. General information

NPI: 1033143235
Provider Name (Legal Business Name): GRANT PARK NURSING HOME LIMITED PARTNERSHIP
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/11/2006
Last Update Date: 03/25/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 NANNIE HELEN BURROUGHS AVE NE
WASHINGTON DC
20019-5506
US

IV. Provider business mailing address

5000 NANNIE HELEN BURROUGHS AVE NE
WASHINGTON DC
20019-5506
US

V. Phone/Fax

Practice location:
  • Phone: 202-399-7504
  • Fax: 202-396-7213
Mailing address:
  • Phone: 202-399-7504
  • Fax: 202-396-7213

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberHFD02-0017
License Number StateDC

VIII. Authorized Official

Name: SANDRA E. DURHAM
Title or Position: MANAGER
Credential:
Phone: 202-399-7504