Provider Demographics
NPI:1104861038
Name:CRYSTAL CITY NURSING CENTER, INC.
Entity Type:Organization
Organization Name:CRYSTAL CITY NURSING CENTER, INC.
Other - Org Name:POTOMAC CENTER
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CORPORATE MANAGER
Authorized Official - Prefix:
Authorized Official - First Name:JANE
Authorized Official - Middle Name:
Authorized Official - Last Name:DROPESKEY
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:610-925-4231
Mailing Address - Street 1:101 E STATE ST
Mailing Address - Street 2:
Mailing Address - City:KENNETT SQUARE
Mailing Address - State:PA
Mailing Address - Zip Code:19348-3109
Mailing Address - Country:US
Mailing Address - Phone:610-925-4436
Mailing Address - Fax:610-925-4351
Practice Address - Street 1:1785 S HAYES ST
Practice Address - Street 2:
Practice Address - City:ARLINGTON
Practice Address - State:VA
Practice Address - Zip Code:22202-2714
Practice Address - Country:US
Practice Address - Phone:703-920-5700
Practice Address - Fax:703-979-8190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-06-17
Last Update Date:2018-08-17
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VANH2655314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC030909900Medicaid
02PVOtherCAREFIRST-PROV/INQ#
241381OtherUNITED - MAMSI
H18OtherCAREFIRST - IND/PPO
47579OtherAMERIGROUP
H18OtherCAREFIRST BLUECHOICE
147180OtherSOUTHERN HEALTH
7100077OtherUNITED - AMERICHOICE
VA004951140Medicaid
0082366OtherAETNA-HMO
=========OtherKAISER
=========OtherMARYLAND PHYSICIAN CARE
H18OtherCAREFIRST - IND/PPO
147180OtherSOUTHERN HEALTH
0082366OtherAETNA-HMO
02PVOtherCAREFIRST-PROV/INQ#
241381OtherUNITED - MAMSI
7100077OtherUNITED - AMERICHOICE
DC030909900Medicaid