Healthcare Provider Details

I. General information

NPI: 1225008873
Provider Name (Legal Business Name): COURTLAND GARDENS NURSING AND REHABILITATION CENTER, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/25/2006
Last Update Date: 11/17/2011
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

7920 SCOTTS LEVEL RD
BALTIMORE MD
21208-2629
US

V. Phone/Fax

Practice location:
  • Phone: 410-521-3600
  • Fax:
Mailing address:
  • Phone: 410-601-2935
  • Fax: 410-601-2925

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number03055
License Number StateMD

VIII. Authorized Official

Name: MR. CLEVELAND SMITH
Title or Position: ASSIT DIRECTOR PATIENT ACCOUNTS
Credential:
Phone: 410-601-2935