Provider Demographics
NPI:1962559104
Name:STODDARD BAPTIST HOME
Entity type:Organization
Organization Name:STODDARD BAPTIST HOME
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:MA,REMEDIOS
Authorized Official - Middle Name:
Authorized Official - Last Name:JOSE-JOHNSON
Authorized Official - Suffix:
Authorized Official - Credentials:RN, LNHA
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:202-328-0421
Practice Address - Street 1:1818 NEWTON ST NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20010-1017
Practice Address - Country:US
Practice Address - Phone:202-328-7400
Practice Address - Fax:202-328-0421
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2007-01-03
Last Update Date:2012-04-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHFD02-0019314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC029880400Medicaid
DC095020Medicare ID - Type Unspecified
DC1281660001Medicare NSC