Healthcare Provider Details

I. General information

NPI: 1154440667
Provider Name (Legal Business Name): HEARTLAND HEALTH CARE CENTER ADELPHI
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/28/2007
Last Update Date: 01/07/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1801 METZEROTT RD
ADELPHI MD
20783-5101
US

IV. Provider business mailing address

1801 METZEROTT RD
ADELPHI MD
20783-5101
US

V. Phone/Fax

Practice location:
  • Phone: 301-434-0500
  • Fax: 301-434-6311
Mailing address:
  • Phone: 301-434-0500
  • Fax: 301-434-6311

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number16012
License Number StateMD

VIII. Authorized Official

Name: MR. CHARLES R WOODBERRY JR.
Title or Position: ADMINISTRATOR
Credential:
Phone: 301-434-0500