| NPI | 1952524332 |
|---|---|
| Entity Type | Organization |
| Authorized Contact | TAMMY LAWSON Program Director 301-777-8422 |
| Organization Subpart ? | No |
| Primary Taxonomy | 314000000X Skilled Nursing Facility (Licence: MD 15905) |
| Additional Taxonomies | 314000000X Skilled Nursing Facility (Licence: MD 15900) |
| Enumeration Date | 2007-04-11 |
| Last Update Date | 2020-08-22 |