1386635209 NPI number — THE WASHINGTON HOME

Table of content: (NPI 1386635209)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1386635209 NPI number — THE WASHINGTON HOME

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
THE WASHINGTON HOME
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
COMMUNITY HOSPICE OF VIRGINIA
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1386635209
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
02/03/2010
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3720 UPTON ST NW
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
WASHINGTON
Provider Business Mailing Address State Name:
DC
Provider Business Mailing Address Postal Code:
20016-2299
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
202-895-0192
Provider Business Mailing Address Fax Number:
202-895-0190

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 N WASHINGTON ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
FALLS CHURCH
Provider Business Practice Location Address State Name:
VA
Provider Business Practice Location Address Postal Code:
22046-3538
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-895-0192
Provider Business Practice Location Address Fax Number:
202-895-0190
Provider Enumeration Date:
10/31/2005

Additional Information

Authorized Official

Authorized Official Last Name:
PAUKSTIS
Authorized Official First Name:
BEVERLY
Authorized Official Middle Name:
Authorized Official Title or Position:
DIRECTOR OF HOSPICE OPERATION
Authorized Official Telephone Number:
202-895-0117

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  058915 , registered in the state of VA ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 4910541 , issued by the state of ( VA ) . This identifiers is of the category "MEDICAID".




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