Provider Demographics
NPI:1801849179
Name:1330 OPCO, L.L.C.
Entity Type:Organization
Organization Name:1330 OPCO, L.L.C.
Other - Org Name:THE HEALTH AND REHABILITATION CENTER AT THOMAS CIRCLE
Other - Org Type:Doing Business As
Authorized Official - Title/Position:VICE PRESIDENT OF 1330 OPCO, L.L.C.
Authorized Official - Prefix:MR
Authorized Official - First Name:THADDEUS
Authorized Official - Middle Name:A
Authorized Official - Last Name:PAUL
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:202-729-5373
Mailing Address - Street 1:1330 MASSACHUSETTS AVENUE, NW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20005-4155
Mailing Address - Country:US
Mailing Address - Phone:202-628-3844
Mailing Address - Fax:202-628-4924
Practice Address - Street 1:1330 MASSACHUSETTS AVENUE NW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20005-4155
Practice Address - Country:US
Practice Address - Phone:202-628-3844
Practice Address - Fax:202-628-4924
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-05-18
Last Update Date:2010-12-13
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHFD020014314000000X
DCHFD02-0014314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC095021Medicare ID - Type Unspecified