Healthcare Provider Details

I. General information

NPI: 1467604850
Provider Name (Legal Business Name): CAPITOL MEDICAL NURSING CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/16/2008
Last Update Date: 10/16/2008
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1310 SOUTHERN AVE SE 6TH FL
WASHINGTON DC
20032-4623
US

IV. Provider business mailing address

1310 SOUTHERN AVE SE 6TH FL
WASHINGTON DC
20032-4623
US

V. Phone/Fax

Practice location:
  • Phone: 202-546-5700
  • Fax:
Mailing address:
  • Phone: 202-546-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. ERIC F RIESEBERG
Title or Position: CHAIRMAN
Credential:
Phone: 202-546-5700