Healthcare Provider Details

I. General information

NPI: 1851618714
Provider Name (Legal Business Name): STODDARD BAPTIST GLOBAL CARE
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 04/30/2010
Last Update Date: 05/15/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2601 18TH ST NE
WASHINGTON DC
20018-1301
US

IV. Provider business mailing address

1818 NEWTON ST NW
WASHINGTON DC
20010-1017
US

V. Phone/Fax

Practice location:
  • Phone: 202-328-7400
  • Fax: 202-328-1083
Mailing address:
  • Phone: 202-328-7400
  • Fax: 202-328-1083

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number StateDC
# 2
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberHFD02-0007
License Number StateDC

VIII. Authorized Official

Name: MR. MAHESH TYAGI
Title or Position: CFO
Credential: CPA
Phone: 202-328-7400