Healthcare Provider Details

I. General information

NPI: 1356371645
Provider Name (Legal Business Name): PARKWAY NURSING & REHABILITATION CENTER, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/03/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

2525 W BELVEDERE AVE
BALTIMORE MD
21215-5203
US

IV. Provider business mailing address

2525 W BELVEDERE AVE
BALTIMORE MD
21215-5203
US

V. Phone/Fax

Practice location:
  • Phone: 410-367-9100
  • Fax: 410-367-6304
Mailing address:
  • Phone: 410-367-9100
  • Fax: 410-367-6304

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number30031
License Number StateMD

VIII. Authorized Official

Name: MRS. ANGIE M GOZALI
Title or Position: ADMINISTRATOR
Credential: LNHA
Phone: 410-367-9100