Provider Demographics
NPI:1598181703
Name:DISTRICT AMPUTEE CARE CENTER, LLC
Entity Type:Organization
Organization Name:DISTRICT AMPUTEE CARE CENTER, LLC
Other - Org Name:
Other - Org Type:
Authorized Official - Title/Position:OWNER OPERATOR
Authorized Official - Prefix:
Authorized Official - First Name:DAVID
Authorized Official - Middle Name:CHRISTIAN
Authorized Official - Last Name:FENTON
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-338-0770
Mailing Address - Street 1:730 24TH ST NW STE 11
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20037-2591
Mailing Address - Country:US
Mailing Address - Phone:202-338-0770
Mailing Address - Fax:202-315-3176
Practice Address - Street 1:730 24TH ST NW STE 11
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20037-2591
Practice Address - Country:US
Practice Address - Phone:202-338-0770
Practice Address - Fax:202-315-3176
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2014-03-12
Last Update Date:2022-12-21
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes335E00000XSuppliersProsthetic/Orthotic Supplier
Provider Identifiers
StateIdentifier IDID TypeIssuer
1030109OtherACM
DC042760100Medicaid
4417OtherCAREFIRST
DC042760100Medicaid