1558531913 NPI number — PARKVILLE NURSING AND REHABILITATION

Table of content: MS. KATHRYN GROSS COLETTA LICSW (NPI 1033309117)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1558531913 NPI number — PARKVILLE NURSING AND REHABILITATION

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
PARKVILLE NURSING AND REHABILITATION
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:
1558531913
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
03/01/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8503 HARFORD RD
Provider Second Line Business Mailing Address:
SUITE F
Provider Business Mailing Address City Name:
BALTIMORE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21234-4698
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-661-1582
Provider Business Mailing Address Fax Number:
410-661-1583

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8503 HARFORD RD
Provider Second Line Business Practice Location Address:
SUITE F
Provider Business Practice Location Address City Name:
BALTIMORE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21234-4698
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-661-1582
Provider Business Practice Location Address Fax Number:
410-661-1583
Provider Enumeration Date:
03/01/2008

Additional Information

Authorized Official

Authorized Official Last Name:
MILES
Authorized Official First Name:
LINNETTE
Authorized Official Middle Name:
Authorized Official Title or Position:
OWNER
Authorized Official Telephone Number:
410-661-1582

Provider Taxonomy Codes

  • Taxonomy code: 251E00000X , with the licence number:  R2583 , 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)





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