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NPI Code Detail

MEDICARE: FENWICK LANDING, LLC

MEDICARE: FENWICK LANDING, 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
1310400000XAssisted Living Facility08AL064FMD

General Provider Information

NPI Number : 1801190947
Entity Type Code : Organization
Provider Name (Legal Business Name) : FENWICK LANDING, LLC
Provider Business Mailing Address
First Line : 11665 DOOLITTLE DR
Second Line :
City : WALDORF
State : MD
Zip : 20602-2898
Country : US
Telephone Number : 301-749-7611
Fax Number : 301-970-2459
Provider Business Practice Location Address
First Line : 11665 DOOLITTLE DR
Second Line :
City : WALDORF
State : MD
Zip : 20602-2898
Country : US
Telephone Number : 301-749-7611
Fax Number : 301-970-2459
Authorized Official
Title or Position : PARTNER
Name : MRS. KARIN M LAKIN
Credential :
Telephone Number : 301-749-7611
Provider Enumeration Date : 01/04/2011
Last Update Date : 01/04/2011

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Directions to “FENWICK LANDING, LLC ” Practice Location

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