MEDICARE: CITIZENS CARE AND REHABILITATION CENTER OF FREDERICK, 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

General Provider Information

NPI Number	:	1578989711
Entity Type Code	:	Organization
Provider Name (Legal Business Name)	:	CITIZENS CARE AND REHABILITATION CENTER OF FREDERICK, LLC

Provider Business Mailing Address
First Line	:	1900 ROSEMONT AVE
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-8249
Country	:	US
Telephone Number	:	301-600-5600
Fax Number	:	301-600-2370

Provider Business Practice Location Address
First Line	:	1900 ROSEMONT AVE
Second Line	:
City	:	FREDERICK
State	:	MD
Zip	:	21702-8249
Country	:	US
Telephone Number	:	301-600-5600
Fax Number	:	301-600-2370

Authorized Official
Title or Position	:	CEO
Name	:	ROBERT G. OWENS
Credential	:	LNHA
Telephone Number	:	410-729-8406

Provider Enumeration Date	:	03/12/2014
Last Update Date	:	06/02/2014

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