1225008873 NPI number — COURTLAND GARDENS NURSING AND REHABILITATION CENTER, INC.

Table of content: (NPI 1770737561)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1225008873 NPI number — COURTLAND GARDENS NURSING AND REHABILITATION CENTER, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COURTLAND GARDENS NURSING AND REHABILITATION CENTER, 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:
JEWISH CONVALESCENT AND NURSING HOME INC
Provider Other Organization Name Type Code:
4
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:
1225008873
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
11/17/2011
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7920 SCOTTS LEVEL RD
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21208-2629
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-601-2935
Provider Business Mailing Address Fax Number:
410-601-2925

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7920 SCOTTS LEVEL RD
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:
21208-2629
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-521-3600
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
01/25/2006

Additional Information

Authorized Official

Authorized Official Last Name:
SMITH
Authorized Official First Name:
CLEVELAND
Authorized Official Middle Name:
Authorized Official Title or Position:
ASSIT DIRECTOR PATIENT ACCOUNTS
Authorized Official Telephone Number:
410-601-2935

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  03055 , 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: 02VJ . This is a "MD BLUE CROSS PROVIDER" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 032677100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: HW7 . This is a "FEDERAL BLUE CROSS PROVID" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




Copyright © 2007-2024 www.npivalidator.com