| NPI | 1487946828 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | LARAE RENETTE WILSON Billing Supervisor 443-205-7422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MD 30AL2686-B) |
| Enumeration Date | 2011-05-04 |
| Last Update Date | 2011-05-04 |