Healthcare Provider Details

I. General information

NPI: 1144333923
Provider Name (Legal Business Name): JOHNS HOPKINS BAYVIEW MEDICAL CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/16/2006
Last Update Date: 06/21/2011
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

5505 HOPKINS BAYVIEW CIRCLE JOHNS HOPKINS BAYVIEW CARE CENTER
BALTIMORE MD
21224
US

IV. Provider business mailing address

P.O. BOX 632064
BALTIMORE MD
21263-2064
US

V. Phone/Fax

Practice location:
  • Phone: 410-550-0756
  • Fax: 410-550-1190
Mailing address:
  • Phone: 443-997-0001
  • Fax: 443-997-0011

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number30086
License Number StateMD

VIII. Authorized Official

Name: MR. RONALD J WERTHMAN
Title or Position: VP, FINANCE, TREASUER, CFO, JHHS
Credential:
Phone: 410-955-6552