Provider Demographics
NPI:1396103891
Name:STODDARD ADULT DAY CARE CENTER LLC
Entity type:Organization
Organization Name:STODDARD ADULT DAY CARE CENTER LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:CEO
Authorized Official - Prefix:
Authorized Official - First Name:STEVEN
Authorized Official - Middle Name:
Authorized Official - Last Name:NASH
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-328-7400
Mailing Address - Street 1:1818 NEWTON ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20010-1017
Mailing Address - Country:US
Mailing Address - Phone:202-328-7400
Mailing Address - Fax:
Practice Address - Street 1:2112 VARNUM ST NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20018-3320
Practice Address - Country:US
Practice Address - Phone:202-541-6153
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:Yes
Parent Organization LBN:STODDARD BAPTIST SERVICES
Parent Organization TIN:<UNAVAIL>
Enumeration Date:2016-01-29
Last Update Date:2016-01-29
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes311ZA0620XNursing & Custodial Care FacilitiesCustodial Care FacilityAdult Care Home