Healthcare Provider Details

I. General information

NPI: 1952632069
Provider Name (Legal Business Name): GRANT PARK SNF, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/29/2010
Last Update Date: 01/29/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5000 NANNIE HELEN BURROUGHS AVE NE
WASHINGTON DC
20019-5506
US

IV. Provider business mailing address

5000 NANNIE HELEN BURROUGHS AVE NE
WASHINGTON DC
20019-5506
US

V. Phone/Fax

Practice location:
  • Phone: 202-399-4505
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code332BN1400X
TaxonomyNursing Facility Supplies (DME)
License Number
License Number State

VIII. Authorized Official

Name: EFRAIM ROOZ
Title or Position: OPERATOR
Credential:
Phone: 646-358-4059