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General NPI Number Information
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NPI Number | 1952632069
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Entity Type | Organization
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Legal Business Name | GRANT PARK SNF, LLC
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Dates
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Enumeration Date | 01/29/2010
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Last Update Date | 01/29/2010
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Provider Practice Location Address
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Address Line | 5000 NANNIE HELEN BURROUGHS AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20019-5506
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Country | US
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Telephone | 202-399-4505
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Fax |
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Provider Business Mailing Address
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Address Line | 5000 NANNIE HELEN BURROUGHS AVE NE
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City | WASHINGTON
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State | DC
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Zip | 20019-5506
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Country | US
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Telephone |
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Fax |
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Authorized Official
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Title or Position | OPERATOR
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Name | EFRAIM ROOZ
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Credential |
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Telephone | 646-358-4059
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 332BN1400X
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Taxonomy Name | Nursing Facility Supplies (DME)
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number |
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License Number State |
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