Healthcare Provider Details

I. General information

NPI: 1699315267
Provider Name (Legal Business Name): SH TOWN SQUARE CORPORATE COMPANY, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/13/2020
Last Update Date: 01/13/2020
Certification Date: 01/13/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9708 BELAIR RD
BALTIMORE MD
21236-1108
US

IV. Provider business mailing address

9708 BELAIR RD
BALTIMORE MD
21236-1108
US

V. Phone/Fax

Practice location:
  • Phone: 410-847-2150
  • Fax:
Mailing address:
  • Phone: 410-847-2150
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. ROBERT SHARKEY
Title or Position: CFO
Credential:
Phone: 844-743-4357