1295214393 NPI number — LEVINDALE HEBREW GERIATRIC CENTER & HOSPITAL INC

Table of content: (NPI 1295214393)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1295214393 NPI number — LEVINDALE HEBREW GERIATRIC CENTER & HOSPITAL INC

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
LEVINDALE HEBREW GERIATRIC CENTER & HOSPITAL 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:
1295214393
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
06/27/2019
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
TIMONIUM BUSINESS PARK
Provider Second Line Business Mailing Address:
1946 GREENSPRING DRIVE, SUITE R
Provider Business Mailing Address City Name:
TIMONIUM
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21093-4152
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:
LIFEBRIDGE HEALTH ADULT DAY SERVICES
Provider Second Line Business Practice Location Address:
5400 OLD COURT ROAD
Provider Business Practice Location Address City Name:
RANDALLSTOWN
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21133
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-601-2361
Provider Business Practice Location Address Fax Number:
Provider Enumeration Date:
08/09/2018

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 PFS
Authorized Official Telephone Number:
410-601-2935

Provider Taxonomy Codes

  • Taxonomy code: 261QA0600X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 780093200 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 272753600 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".
  • Identifier: 333894100 , issued by the state of ( MD ) . This identifiers is of the category "MEDICAID".