Mount Vernon Nursing Center Associates, LLLP

Primary specialty

Skilled Nursing FacilityTaxonomy code 314000000X

License

NH2634 Issued in VA

Legal business name

MOUNT VERNON NURSING CENTER ASSOCIATES, LLLP

Practice address

8111 Tis Well Dr
Alexandria, VA 22306-3211

Phone

(703) 360-4000

Fax

(703) 360-9325

NPI assigned

Aug 1, 2006

Organization subpart

No

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name

Mr. Robert K Demaria

Title

Administrator

Phone

(703) 360-4000

Specialties & licenses 2

Addresses

Other identifiers 1

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1154390400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1285632000000",
    "number": "1497761175",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "8111 TIS WELL DR",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223063211",
            "telephone_number": "703-360-4000",
            "fax_number": "703-360-9325"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "8111 TIS WELL DR",
            "city": "ALEXANDRIA",
            "state": "VA",
            "postal_code": "223063211",
            "telephone_number": "703-360-4000",
            "fax_number": "703-360-9325"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "MOUNT VERNON NURSING CENTER ASSOCIATES, LLLP",
        "organizational_subpart": "NO",
        "enumeration_date": "2006-08-01",
        "last_updated": "2010-09-28",
        "status": "A",
        "authorized_official_last_name": "DEMARIA",
        "authorized_official_first_name": "ROBERT",
        "authorized_official_middle_name": "K",
        "authorized_official_title_or_position": "ADMINISTRATOR",
        "authorized_official_telephone_number": "703-360-4000",
        "authorized_official_name_prefix": "Mr."
    },
    "taxonomies": [
        {
            "code": "313M00000X",
            "taxonomy_group": "",
            "desc": "Nursing Facility/Intermediate Care Facility",
            "state": "VA",
            "license": "NH2634",
            "primary": false
        },
        {
            "code": "314000000X",
            "taxonomy_group": "",
            "desc": "Skilled Nursing Facility",
            "state": "VA",
            "license": "NH2634",
            "primary": true
        }
    ],
    "identifiers": [
        {
            "code": "05",
            "desc": "MEDICAID",
            "issuer": null,
            "identifier": "004952111",
            "state": "VA"
        }
    ],
    "endpoints": [],
    "other_names": []
}

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• Mount Vernon Orthopaedics Assoc
• Mount Vernon Physical Therapy LC
• Mount Vernon Primary Care Associates, PLLC
• Mount Vernon Rehabilitation Medicine Associates
• Soumeye Moustapha

• All providers in Alexandria, VA
• Skilled Nursing Facility in Virginia

• NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Sep 28, 2010; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
• National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.