1376540856 NPI number — TOWSON REHABILITATION CENTER LLC

Table of content: (NPI 1376540856)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1376540856 NPI number — TOWSON REHABILITATION CENTER LLC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
TOWSON REHABILITATION CENTER 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:
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:
1376540856
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
04/20/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
7401 OSLER DR
Provider Second Line Business Mailing Address:
SUITE 110
Provider Business Mailing Address City Name:
TOWSON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21204-7673
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-296-8888
Provider Business Mailing Address Fax Number:
410-296-6745

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
7401 OSLER DR
Provider Second Line Business Practice Location Address:
SUITE 110
Provider Business Practice Location Address City Name:
TOWSON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21204-7673
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-296-8888
Provider Business Practice Location Address Fax Number:
410-296-6745
Provider Enumeration Date:
06/30/2005

Additional Information

Authorized Official

Authorized Official Last Name:
FIORINO
Authorized Official First Name:
MARK
Authorized Official Middle Name:
Authorized Official Title or Position:
PRESIDENT
Authorized Official Telephone Number:
410-296-8888

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X , 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: 319813 . This is a "BC/BS OF PENNSYLVANIA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 1373021 . This is a "HIMARK BC/BS OF PA" identifier , issued by the state of ( PA ) . This identifiers is of the category "OTHER".
  • Identifier: 435557 . This is a "ANTHEM TRIGON" identifier , issued by the state of ( VA ) . This identifiers is of the category "OTHER".
  • Identifier: 137008100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: LN91 . This is a "BC/BS OF MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: 4040326 . This is a "BC/BS OF TENNESSEE" identifier , issued by the state of ( TN ) . This identifiers is of the category "OTHER".
  • Identifier: W226 . This is a "FEDERAL BC/BS" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".




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