Provider Demographics
NPI:1386635209
Name:THE WASHINGTON HOME
Entity Type:Organization
Organization Name:THE WASHINGTON HOME
Other - Org Name:COMMUNITY HOSPICE OF VIRGINIA
Other - Org Type:Doing Business As
Authorized Official - Title/Position:DIRECTOR OF HOSPICE OPERATION
Authorized Official - Prefix:MS
Authorized Official - First Name:BEVERLY
Authorized Official - Middle Name:
Authorized Official - Last Name:PAUKSTIS
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-895-0117
Mailing Address - Street 1:3720 UPTON ST NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20016-2299
Mailing Address - Country:US
Mailing Address - Phone:202-895-0192
Mailing Address - Fax:202-895-0190
Practice Address - Street 1:520 N WASHINGTON ST
Practice Address - Street 2:
Practice Address - City:FALLS CHURCH
Practice Address - State:VA
Practice Address - Zip Code:22046-3538
Practice Address - Country:US
Practice Address - Phone:202-895-0192
Practice Address - Fax:202-895-0190
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-31
Last Update Date:2010-02-03
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
VA058915251G00000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes251G00000XAgenciesHospice Care, Community Based
Provider Identifiers
StateIdentifier IDID TypeIssuer
VA4910541Medicaid
VA4910541Medicaid