Provider Demographics
NPI:1467604850
Name:CAPITOL MEDICAL NURSING CENTER, LLC
Entity Type:Organization
Organization Name:CAPITOL MEDICAL NURSING CENTER, LLC
Other - Org Name:UNITED MEDICAL NURSING CENTER, LLC
Other - Org Type:Doing Business As
Authorized Official - Title/Position:CHAIRMAN
Authorized Official - Prefix:MR
Authorized Official - First Name:ERIC
Authorized Official - Middle Name:F
Authorized Official - Last Name:RIESEBERG
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-546-5700
Mailing Address - Street 1:1310 SOUTHERN AVE SE
Mailing Address - Street 2:6TH FL
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-4623
Mailing Address - Country:US
Mailing Address - Phone:202-546-5700
Mailing Address - Fax:
Practice Address - Street 1:1310 SOUTHERN AVE SE
Practice Address - Street 2:6TH FL
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-4623
Practice Address - Country:US
Practice Address - Phone:202-546-5700
Practice Address - Fax:
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2008-10-16
Last Update Date:2008-10-16
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility