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NPI Code Detail

MEDICARE: 2101 FAIRLAND ROAD OPERATIONS LLC

MEDICARE: 2101 FAIRLAND ROAD OPERATIONS 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
1314000000XSkilled Nursing Facility15-012MD

Other Identifiers

# Provider Identifier Provider Identifier Type Provider Identifier State Provider Identifier Issuer
1MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program
2MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number : 1487962536
Entity Type Code : Organization
Provider Name (Legal Business Name) : 2101 FAIRLAND ROAD OPERATIONS LLC
Provider Business Mailing Address
First Line : 101 E STATE ST
Second Line :
City : KENNETT SQUARE
State : PA
Zip : 19348-3109
Country : US
Telephone Number : 610-925-4436
Fax Number : 610-347-4099
Provider Business Practice Location Address
First Line : 2101 FAIRLAND RD
Second Line :
City : SILVER SPRING
State : MD
Zip : 20904-5427
Country : US
Telephone Number : 301-384-6161
Fax Number :
Authorized Official
Title or Position : ASSISTANT SECRETARY
Name : MICHAEL T. BERG
Credential :
Telephone Number : 505-468-4752
Provider Enumeration Date : 09/22/2010
Last Update Date : 08/29/2019

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