Provider Demographics
NPI:1356456289
Name:DCA HADLEY SNF LLC
Entity type:Organization
Organization Name:DCA HADLEY SNF LLC
Other - Org Name:<UNAVAIL>
Other - Org Type:
Authorized Official - Title/Position:VP & COO
Authorized Official - Prefix:
Authorized Official - First Name:SWENDA
Authorized Official - Middle Name:
Authorized Official - Last Name:BEITPOULICE
Authorized Official - Suffix:
Authorized Official - Credentials:
Authorized Official - Phone:562-453-7474
Mailing Address - Street 1:4601 MLK JR AVENUE SW
Mailing Address - Street 2:
Mailing Address - City:WASHINGTON
Mailing Address - State:DC
Mailing Address - Zip Code:20032-1131
Mailing Address - Country:US
Mailing Address - Phone:202-741-4170
Mailing Address - Fax:202-373-5906
Practice Address - Street 1:4601 MLK JR AVENUE SW
Practice Address - Street 2:
Practice Address - City:WASHINGTON
Practice Address - State:DC
Practice Address - Zip Code:20032-1131
Practice Address - Country:US
Practice Address - Phone:202-741-4170
Practice Address - Fax:202-373-5906
EIN:<UNAVAIL>
Is Organization Subpart?:No
Parent Organization LBN:
Parent Organization TIN:
Enumeration Date:2006-08-20
Last Update Date:2022-01-27
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DCHFD020023314000000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes314000000XNursing & Custodial Care FacilitiesSkilled Nursing Facility
Provider Identifiers
StateIdentifier IDID TypeIssuer
DC025890300Medicaid
DC025890300Medicaid