1477546257 NPI number — LOCHEARN NURSING HOME LLC

Table of Contents

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1477546257 NPI number — LOCHEARN NURSING HOME LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LOCHEARN NURSING HOME LLC
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 LOCHEARN
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:
1477546257
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:
SUITE 210B
Provider Business Mailing Address City Name:
PASADENA
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21122-1075
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:
4800 SETON DR
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21215-3210
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-358-3410
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/26/2005

Additional Information

Authorized Official

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

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  30-092 , 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: 407598600 . This is a "MEDICAID DME" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 407599400 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




Copyright © 2007-2024 www.npivalidator.com