Healthcare Provider Details

I. General information

NPI: 1639576192
Provider Name (Legal Business Name): BRINTON WOODS OF WASHINGTON DC, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/28/2014
Last Update Date: 11/28/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1380 SOUTHERN AVE SE
WASHINGTON DC
20032-4623
US

IV. Provider business mailing address

9515 DEERECO RD SUITE 407
TIMONIUM MD
21093-2116
US

V. Phone/Fax

Practice location:
  • Phone: 202-279-5880
  • Fax:
Mailing address:
  • Phone: 410-560-4925
  • Fax: 410-560-4927

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberHFD020011
License Number StateDC

VIII. Authorized Official

Name: DAREN CORTESE
Title or Position: PRESIDENT
Credential:
Phone: 410-560-4925