Healthcare Provider Details

I. General information

NPI: 1598736753
Provider Name (Legal Business Name): CARROLL MANOR
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/27/2006
Last Update Date: 06/23/2025
Certification Date: 06/23/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

725 BUCHANAN ST NE
WASHINGTON DC
20017-2340
US

IV. Provider business mailing address

725 BUCHANAN ST NE
WASHINGTON DC
20017-2340
US

V. Phone/Fax

Practice location:
  • Phone: 202-269-7100
  • Fax: 202-854-7816
Mailing address:
  • Phone: 202-269-7100
  • Fax: 202-854-7816

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberHFD02-0027
License Number StateDC

VIII. Authorized Official

Name: ERIN SHADBOLT
Title or Position: CEO
Credential:
Phone: 314-729-3500