Healthcare Provider Details

I. General information

NPI: 1033524186
Provider Name (Legal Business Name): COURTLAND, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/27/2014
Last Update Date: 08/07/2014
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7920 SCOTTS LEVEL RD
BALTIMORE MD
21208-2629
US

IV. Provider business mailing address

8028 RITCHIE HWY SUITE 210B
PASADENA MD
21122-1075
US

V. Phone/Fax

Practice location:
  • Phone: 410-521-3600
  • Fax:
Mailing address:
  • Phone: 410-766-1995
  • Fax: 410-761-6095

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number
License Number State

VIII. Authorized Official

Name: MR. BRIAN FINGLASS
Title or Position: CFO
Credential: CPA
Phone: 410-766-1995