Southern Ave Sp LLC
NPI #1306433644 in Washington DC, District of Columbia
Provider Information
- NPI Number
- 1306433644
- Entity Type
- Organization
- Organization Name
- Southern Ave Sp LLC
- Primary Specialty
- Assisted Living Facility
- Enumeration Date
- Dec 21, 2020
- Last Updated
- Jan 26, 2021
Practice Location
- Address
- 4656 LIVINGSTON RD. SE
- City
- Washington DC
- State
- District of Columbia
- ZIP Code
- 20032
- Phone
- (260) 755-2292
Authorized Official
- Name
- RYAN PERSON
- Title
- DIRECTOR OF BUSINESS DEVELOPMENT
- Phone
- (260) 413-4159
Specialties & Taxonomy Codes
| Specialty |
|---|
| Assisted Living Facility |
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