1922051218 NPI number — OAK CREST VILLAGE, INC.

Table of content: (NPI 1922051218)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1922051218 NPI number — OAK CREST VILLAGE, INC.

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
OAK CREST VILLAGE, 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:
1922051218
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
01/21/2015
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
8820 WALTHER BLVD
Provider Second Line Business Mailing Address:
ATTN: EXECUTIVE DIRECTOR
Provider Business Mailing Address City Name:
PARKVILLE
Provider Business Mailing Address State Name:
MD
Provider Business Mailing Address Postal Code:
21234-9025
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
410-655-1000
Provider Business Mailing Address Fax Number:
410-204-7237

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
8830 WALTHER BLVD
Provider Second Line Business Practice Location Address:
ATTN: REHABILITATION MANAGER
Provider Business Practice Location Address City Name:
PARKVILLE
Provider Business Practice Location Address State Name:
MD
Provider Business Practice Location Address Postal Code:
21234-9020
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
410-655-1000
Provider Business Practice Location Address Fax Number:
410-204-7237
Provider Enumeration Date:
05/18/2006

Additional Information

Authorized Official

Authorized Official Last Name:
WALTER
Authorized Official First Name:
JAMES
Authorized Official Middle Name:
K
Authorized Official Title or Position:
FINANCE DIRECTOR
Authorized Official Telephone Number:
410-402-2315

Provider Taxonomy Codes

  • Taxonomy code: 261QR0400X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

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





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