Healthcare Provider Details

I. General information

NPI: 1396044608
Provider Name (Legal Business Name): ACC GREEN HOUSE RESIDENCES, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/25/2011
Last Update Date: 02/17/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1010 E 33RD ST
BALTIMORE MD
21218-3636
US

IV. Provider business mailing address

1966 GREENSPRING DR SUITE 200 ATTN: VALARIE WEEMS
TIMONIUM MD
21093-4117
US

V. Phone/Fax

Practice location:
  • Phone: 443-798-3412
  • Fax:
Mailing address:
  • Phone: 443-798-3412
  • Fax:

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. SCOTT W. BECKER
Title or Position: TREASURER
Credential:
Phone: 443-798-3443