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General NPI Number Information
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NPI Number | 1174082549
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Entity Type | Organization
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Legal Business Name | PARADISE AT GEORGIA AVE, LLC
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Dates
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Enumeration Date | 03/15/2019
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Last Update Date | 03/15/2019
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Provider Practice Location Address
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Address Line | 5100 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20011-3958
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Country | US
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Telephone | 202-774-8553
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Fax |
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Provider Business Mailing Address
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Address Line | 5100 GEORGIA AVE NW
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City | WASHINGTON
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State | DC
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Zip | 20011-3958
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Country | US
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Telephone | 202-774-8553
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Fax |
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Authorized Official
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Title or Position | EXECUTIVE DIRECTOR
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Name | MR. LEONARD WASHINGTON SMITH JR.
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Credential |
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Telephone | 202-880-4577
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 310400000X
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Taxonomy Name | Assisted Living Facility
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License Number |
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License Number State |
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