Healthcare Provider Details

I. General information

NPI: 1043214745
Provider Name (Legal Business Name): SANDTOWN WINCHESTER NURSING HOME, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 06/09/2005
Last Update Date: 09/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1000 N GILMOR ST
BALTIMORE MD
21217-2207
US

IV. Provider business mailing address

8028 RITCHIE HWY STE 210B
PASADENA MD
21122-1059
US

V. Phone/Fax

Practice location:
  • Phone: 410-669-2750
  • Fax: 410-669-3875
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 Number30-094
License Number StateMD

VIII. Authorized Official

Name: BRIAN FINGLASS
Title or Position: CFO/VP OF FINANCE
Credential:
Phone: 410-766-1995