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NPI Code Detail

MEDICARE: 700 TOLL HOUSE AVENUE OPERATIONS LLC

MEDICARE: 700 TOLL HOUSE AVENUE 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
1225100000XPhysical Therapist10002MD
2225X00000XOccupational Therapist10002MD
3235Z00000XSpeech-Language Pathologist10002MD
4314000000XSkilled Nursing Facility10002MD

Other Identifiers

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

General Provider Information

NPI Number : 1861846248
Entity Type Code : Organization
Provider Name (Legal Business Name) : 700 TOLL HOUSE AVENUE OPERATIONS LLC
Provider Business Mailing Address
First Line : 347 BALLENGER CENTER DR
Second Line :
City : FREDERICK
State : MD
Zip : 21703-7095
Country : US
Telephone Number : 301-663-5181
Fax Number :
Provider Business Practice Location Address
First Line : 347 BALLENGER CENTER DR
Second Line :
City : FREDERICK
State : MD
Zip : 21703-7095
Country : US
Telephone Number : 301-663-5181
Fax Number :
Authorized Official
Title or Position : ASSISTANT SECRETARY
Name : MICHAEL T. BERG
Credential :
Telephone Number : 505-468-4752
Provider Enumeration Date : 04/21/2016
Last Update Date : 03/08/2018

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