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General NPI Number Information
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NPI Number | 1962559104
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Entity Type | Organization
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Legal Business Name | STODDARD BAPTIST HOME
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Dates
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Enumeration Date | 01/03/2007
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Last Update Date | 04/16/2012
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Provider Practice Location Address
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Address Line | 1818 NEWTON ST NW
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City | WASHINGTON
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State | DC
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Zip | 20010-1017
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Country | US
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Telephone | 202-328-7400
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Fax | 202-328-0421
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Provider Business Mailing Address
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Address Line | 1818 NEWTON ST NW
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City | WASHINGTON
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State | DC
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Zip | 20010-1017
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Country | US
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Telephone | 202-328-7400
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Fax | 202-328-0421
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Authorized Official
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Title or Position | ADMINISTRATOR
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Name | MRS. MA,REMEDIOS JOSE-JOHNSON
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Credential | RN, LNHA
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Telephone | 202-328-7400
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 314000000X
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Taxonomy Name | Skilled Nursing Facility
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License Number | HFD02-0019
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License Number State | DC
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