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NPI Code Detail

MEDICARE: GRANT PARK SNF, LLC

MEDICARE: GRANT PARK SNF, LLC
Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

# Taxonomy Code Taxonomy License Number License Number State
1332BN1400XNursing Facility Supplies (DME)
2314000000XSkilled Nursing Facility

General Provider Information

NPI Number : 1952632069
Entity Type Code : Organization
Provider Name (Legal Business Name) : GRANT PARK SNF, LLC
Provider Business Mailing Address
First Line : 5000 NANNIE HELEN BURROUGHS AVE NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20019-5506
Country : US
Telephone Number :
Fax Number :
Provider Business Practice Location Address
First Line : 5000 NANNIE HELEN BURROUGHS AVE NE
Second Line :
City : WASHINGTON
State : DC
Zip : 20019-5506
Country : US
Telephone Number : 202-399-4505
Fax Number :
Authorized Official
Title or Position : OPERATOR
Name : EFRAIM ROOZ
Credential :
Telephone Number : 646-358-4059
Provider Enumeration Date : 01/29/2010
Last Update Date : 01/29/2010

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