Provider Demographics
NPI:1033143235
Name:GRANT PARK NURSING HOME LIMITED PARTNERSHIP
Entity Type:Organization
Organization Name:GRANT PARK NURSING HOME LIMITED PARTNERSHIP
Other - Org Name:GRANT PARK CARE CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:SANDRA
Authorized Official - Middle Name:E
Authorized Official - Last Name:DURHAM
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-399-7504
Mailing Address - Street 1:5000 NANNIE HELEN BURROUGHS AVE NE
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20019-5506
Mailing Address - Country:US
Mailing Address - Phone:202-399-7504
Mailing Address - Fax:202-396-7213
Practice Address - Street 1:5000 NANNIE HELEN BURROUGHS AVE NE
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20019-5506
Practice Address - Country:US
Practice Address - Phone:202-399-7504
Practice Address - Fax:202-396-7213
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-07-11
Last Update Date:2010-03-25
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHFD02-0017314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC032716100Medicaid
DC032716100Medicaid