1790706935 NPI number — CAPITAL HOSPICE

Table of content: (NPI 1790706935)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1790706935 NPI number — CAPITAL HOSPICE

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAPITAL HOSPICE
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:
Provider Other Organization Name Type Code:
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:
1790706935
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/15/2022
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
3180 FAIRVIEW PARK DR STE 500
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
FALLS CHURCH
Provider Business Mailing Address State Name:
VA
Provider Business Mailing Address Postal Code:
22042-4583
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
703-538-2066
Provider Business Mailing Address Fax Number:
703-532-1054

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
5225 WISCONSIN AVE NW STE 503
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
WASHINGTON
Provider Business Practice Location Address State Name:
DC
Provider Business Practice Location Address Postal Code:
20015-2034
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
202-244-8300
Provider Business Practice Location Address Fax Number:
202-244-1413
Provider Enumeration Date:
07/22/2006

Additional Information

			
		

Authorized Official

Authorized Official Last Name:
KESTENBAUM
Authorized Official First Name:
MATTHEW
Authorized Official Middle Name:
GUY
Authorized Official Title or Position:
CMO
Authorized Official Telephone Number:
703-957-1888

Provider Taxonomy Codes

  • Taxonomy code: 251G00000X , with the licence number:  54192XXXX-65000704 , registered in the state of DC ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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

  • Identifier: 022013500 , issued by the state of ( DC ) . This identifiers is of the category "MEDICAID".
  • Identifier: 117743 . This is a "KAISER PERMANENTE" identifier , issued by the state of ( DC ) . This identifiers is of the category "OTHER".