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NPI Code Detail

MEDICARE: SOUTH RIVER NURSING AND REHAB CENTER LLC

MEDICARE: SOUTH RIVER NURSING AND REHAB CENTER 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 Facility

General Provider Information

NPI Number : 1861359531
Entity Type Code : Organization
Provider Name (Legal Business Name) : SOUTH RIVER NURSING AND REHAB CENTER LLC
Provider Business Mailing Address
First Line : 144 WASHINGTON RD
Second Line :
City : EDGEWATER
State : MD
Zip : 21037-1412
Country : US
Telephone Number : 410-956-5000
Fax Number :
Provider Business Practice Location Address
First Line : 144 WASHINGTON RD
Second Line :
City : EDGEWATER
State : MD
Zip : 21037-1412
Country : US
Telephone Number : 410-956-5000
Fax Number :
Authorized Official
Title or Position : AUTHORIZED OFFICIAL
Name : MATT KOSMAN
Credential :
Telephone Number : 855-557-1427
Provider Enumeration Date : 01/06/2026
Last Update Date : 04/07/2026

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Directions to “SOUTH RIVER NURSING AND REHAB CENTER LLC ” Practice Location

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