Provider Demographics
NPI:1639168743
Name:ABRAHAM AND LAURA LISNER HOME FOR AGED WOMEN
Entity Type:Organization
Organization Name:ABRAHAM AND LAURA LISNER HOME FOR AGED WOMEN
Other - Org Name:LISNER-LOUISE-DICKSON-HURT HOME
Other - Org Type:Doing Business As
Authorized Official - Title/Position:ADMINISTRATOR
Authorized Official - Prefix:MR
Authorized Official - First Name:L.
Authorized Official - Middle Name:WARD
Authorized Official - Last Name:OREM
Authorized Official - Suffix:
Authorized Official - Credentials:LNHA
Authorized Official - Phone:202-966-6667
Mailing Address - Street 1:5425 WESTERN AVE NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20015-2931
Mailing Address - Country:US
Mailing Address - Phone:202-966-6667
Mailing Address - Fax:202-362-0360
Practice Address - Street 1:5425 WESTERN AVE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20015-2931
Practice Address - Country:US
Practice Address - Phone:202-966-6667
Practice Address - Fax:202-362-0360
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2005-10-20
Last Update Date:2017-09-18
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCALR-0002310400000X
DCHFD020015314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes310400000XNursing & Custodial Care FacilitiesAssisted Living Facility
No314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC095025Medicare ID - Type UnspecifiedLONG TERM CARE FACILITY