Healthcare Provider Details

I. General information

NPI: 1770578288
Provider Name (Legal Business Name): INGLESIDE AT ROCK CREEK, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/12/2005
Last Update Date: 01/30/2025
Certification Date: 01/30/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3050 MILITARY ROAD, NW
WASHINGTON DC
20015
US

IV. Provider business mailing address

3050 MILITARY ROAD, NW
WASHINGTON DC
20015
US

V. Phone/Fax

Practice location:
  • Phone: 202-596-3131
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberHFD02-0008
License Number StateDC

VIII. Authorized Official

Name: MR. LYNN GRREN
Title or Position: CFO
Credential:
Phone: 240-429-0585