MEDICARE: 19301 WATKINS MILL ROAD OPERATING COMPANY, LLC

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	314000000X	Skilled Nursing Facility		MD

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1316945181
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	19301 WATKINS MILL ROAD OPERATING COMPANY, LLC

Provider Business Mailing Address
First Line	:	19301 WATKINS MILL RD.
Second Line	:
City	:	MONTGOMERY VILLAGE
State	:	MD
Zip	:	20886
Country	:	US
Telephone Number	:	301-527-2500
Fax Number	:	301-527-2525

Provider Business Practice Location Address
First Line	:	19301 WATKINS MILL RD.
Second Line	:
City	:	MONTGOMERY VILLAGE
State	:	MD
Zip	:	20886
Country	:	US
Telephone Number	:	301-527-2500
Fax Number	:	301-527-2525

Authorized Official
Title or Position	:	EXECUTIVE VP & GENERAL COUNSEL
Name	:	MR. A. ALBERTO LUGO
Credential	:
Telephone Number	:	201-242-4000

Provider Enumeration Date	:	07/14/2005
Last Update Date	:	08/13/2015

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