Healthcare Provider Details

I. General information

NPI: 1710852785
Provider Name (Legal Business Name): NATIONAL HARBORSIDE SNF OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/08/2025
Last Update Date: 10/08/2025
Certification Date: 10/08/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 MARTIN LUTHER KING JR AVE SW
WASHINGTON DC
20032-1131
US

IV. Provider business mailing address

4601 MARTIN LUTHER KING JR AVE SW
WASHINGTON DC
20032-1131
US

V. Phone/Fax

Practice location:
  • Phone: 202-574-5700
  • Fax:
Mailing address:
  • Phone: 202-574-5700
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: JOSEPH LIEBERMAN
Title or Position: VICE PRESIDENT OF PROCUREMENT
Credential:
Phone: 516-855-5504