1174527055 NPI number — BAY MANOR NURSING HOME, INC.

Table of content: (NPI 1174527055)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1174527055 NPI number — BAY MANOR NURSING HOME, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
BAY MANOR NURSING HOME, INC.
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:
FUTURECARE CHESAPEAKE
Provider Other Organization Name Type Code:
3
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:
1174527055
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/17/2009
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8028 RITCHIE HWY
Provider Second Line Business Mailing Address:
STE 210B
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21122-1059
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-766-1995
Provider Business Mailing Address Fax Number:
410-761-6095

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
305 COLLEGE PKWY
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ARNOLD
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21012-2912
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-647-0015
Provider Business Practice Location Address Fax Number:
410-647-0019
Provider Enumeration Date:
06/09/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FINGLASS
Authorized Official First Name:
BRIAN
Authorized Official Middle Name:
Authorized Official Title or Position:
CFO/VP OF FINANCE
Authorized Official Telephone Number:
410-766-1995

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  02-004 , 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: 215767100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 754898200 . This is a "MEDICAID DME" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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