Healthcare Provider Details

I. General information

NPI: 1639168743
Provider Name (Legal Business Name): ABRAHAM AND LAURA LISNER HOME FOR AGED WOMEN
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/20/2005
Last Update Date: 09/18/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5425 WESTERN AVE NW
WASHINGTON DC
20015-2931
US

IV. Provider business mailing address

5425 WESTERN AVE NW
WASHINGTON DC
20015-2931
US

V. Phone/Fax

Practice location:
  • Phone: 202-966-6667
  • Fax: 202-362-0360
Mailing address:
  • Phone: 202-966-6667
  • Fax: 202-362-0360

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberHFD020015
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License NumberALR-0002
License Number StateDC

VIII. Authorized Official

Name: MR. L. WARD OREM
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 202-966-6667