Healthcare Provider Details

I. General information

NPI: 1477767390
Provider Name (Legal Business Name): WASHINGTON VILLAGE FAMILY CARE CENTER
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2007
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 WASHINGTON BLVD
BALTIMORE MD
21230-2350
US

IV. Provider business mailing address

700 WASHINGTON BLVD
BALTIMORE MD
21230-2350
US

V. Phone/Fax

Practice location:
  • Phone: 410-362-3000
  • Fax:
Mailing address:
  • Phone: 410-362-3000
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261Q00000X
TaxonomyClinic/Center
License Number
License Number State

VIII. Authorized Official

Name: BERNADETTE KEANE
Title or Position: DIRECTOR
Credential:
Phone: 410-362-4499