1215930003 NPI number — COLLINGSWOOD NURSING FACILITIES INC

Table of content: (NPI 1215930003)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1215930003 NPI number — COLLINGSWOOD NURSING FACILITIES INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
COLLINGSWOOD NURSING FACILITIES 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:
Provider Other Organization Name Type Code:
6
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:
1215930003
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
09/11/2018
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
299 HURLEY AVE
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
ROCKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
20850-3118
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
301-762-8900
Provider Business Mailing Address Fax Number:
301-762-8020

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
299 HURLEY AVE
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
ROCKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
20850-3118
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
301-762-8900
Provider Business Practice Location Address Fax Number:
301-762-8020
Provider Enumeration Date:
05/24/2005

Additional Information

Authorized Official

Authorized Official Last Name:
WHETZEL
Authorized Official First Name:
LEAH
Authorized Official Middle Name:
T
Authorized Official Title or Position:
ADMINISTRATOR
Authorized Official Telephone Number:
301-762-8900

Provider Taxonomy Codes

  • Taxonomy code: 314000000X , 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: 02FVCO . This is a "BLUECROSS MARYLAND" identifier , issued by the state of ( MD ) . This identifiers is of the category "OTHER".
  • Identifier: RE6 . This is a "BCBSNCA" identifier . This identifiers is of the category "OTHER".
  • Identifier: 7100090 . This is a "EVERCARE PROVIDER NUMBER" identifier . This identifiers is of the category "OTHER".
  • Identifier: 155327500 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".




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