1164574604 NPI number — HCR MANORCARE TOWSON

Table of content: (NPI 1164574604)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1164574604 NPI number — HCR MANORCARE TOWSON

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
HCR MANORCARE TOWSON
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
Provider Other Organization Name Type Code:
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1164574604
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
509 E JOPPA RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21286-5404
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-828-9494
Provider Business Mailing Address Fax Number:
410-828-9180

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
509 E JOPPA RD
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21286-5404
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-828-9494
Provider Business Practice Location Address Fax Number:
410-828-9180
Provider Enumeration Date:
01/17/2007

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
DEAN
Authorized Official Middle Name:
A
Authorized Official Title or Position:
NURSING HOME ADMINISTRATOR
Authorized Official Telephone Number:
410-828-9494

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  03-022 , registered in the state of MD ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 216648 . This is a "KAISER PERMANENTE PROV#" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: PW4 . This is a "BC FEDERAL PROVIDER #" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: C 215054 . This is a "UNITED AMERICAN PROVIDER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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