1821080805 NPI number — CAROLINE NURSING HOME, INC

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 1821080805 NPI number — CAROLINE NURSING HOME, INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
CAROLINE 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:
CAROLINE NURSING & REHAB CENTER, INC
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:
1821080805
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
08/22/2020
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
520 KERR AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
DENTON
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21629-1343
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-479-2130
Provider Business Mailing Address Fax Number:
410-479-3057

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
520 KERR AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
DENTON
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21629-1343
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-479-2130
Provider Business Practice Location Address Fax Number:
410-479-3057
Provider Enumeration Date:
08/17/2005

Additional Information

Authorized Official

Authorized Official Last Name:
SCHULTZ
Authorized Official First Name:
NORMA
Authorized Official Middle Name:
L.
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
410-479-2130

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , with the licence number:  05-001 , 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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