Provider Demographics
NPI:1154484251
Name:IDEAL NURSING SERVICES INC
Entity Type:Organization
Organization Name:IDEAL NURSING SERVICES INC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:PRESIDENT ADMINISTRATOR
Authorized Official - Prefix:MRS
Authorized Official - First Name:CAROL
Authorized Official - Middle Name:JEAN
Authorized Official - Last Name:GRANT GORDON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-723-0304
Mailing Address - Street 1:820 UPSHUR STREET NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20011
Mailing Address - Country:US
Mailing Address - Phone:202-723-0304
Mailing Address - Fax:202-723-0367
Practice Address - Street 1:820 UPSHUR STREET NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20011
Practice Address - Country:US
Practice Address - Phone:202-723-0304
Practice Address - Fax:202-723-0367
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-12-19
Last Update Date:2015-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC097036251E00000X
DCHCA-0014385H00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251E00000XAgenciesHome Health
No385H00000XRespite Care FacilityRespite Care
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC025398700Medicaid
DC025400100Medicaid
DC025400100Medicaid