Basic Information
| Provider Information | |||||||||
| NPI: | 1861445876 | ||||||||
| EntityType: | 2 | ||||||||
| ReplacementNPI: | |||||||||
| OrganizationName: | SOLOMON HOLDINGS I - THE TRIANGLE, LLC | ||||||||
| LastName: | |||||||||
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| Credential: | |||||||||
| OtherOrganizationName: | BRIGHTON GARDENS OF TUCKERMAN | ||||||||
| OtherOrganizationType: | 3 | ||||||||
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| Mailing Information | |||||||||
| Address1: | 7900 WESTPARK DR | ||||||||
| Address2: | T-900, ATT: MEDICARE BILLING, M. GARCIA | ||||||||
| City: | MC LEAN | ||||||||
| State: | VA | ||||||||
| PostalCode: | 221024242 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7038540823 | ||||||||
| FaxNumber: | 7038540164 | ||||||||
| Practice Location | |||||||||
| Address1: | 5550 TUCKERMAN LN | ||||||||
| Address2: | |||||||||
| City: | ROCKVILLE | ||||||||
| State: | MD | ||||||||
| PostalCode: | 208524683 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 3018978566 | ||||||||
| FaxNumber: | 3018978845 | ||||||||
| Other Information | |||||||||
| ProviderEnumerationDate: | 05/19/2006 | ||||||||
| LastUpdateDate: | 12/12/2012 | ||||||||
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| AuthorizedOfficialLastName: | MELL | ||||||||
| AuthorizedOfficialFirstName: | MARY | ||||||||
| AuthorizedOfficialMiddleName: | |||||||||
| AuthorizedOfficialTitleorPosition: | EXECUTIVE DIRECTOR | ||||||||
| AuthorizedOfficialTelephone: | 3018978566 | ||||||||
| IsSoleProprietor: | |||||||||
| IsOrganizationSubpart: | N | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 314000000X | 15072 | MD | Y | Nursing & Custodial Care Facilities | Skilled Nursing Facility |
ID Information
| ID | Type | State | Issuer | Description | 403406600 | 05 | MD | MEDICAID |