Healthcare Provider Details

I. General information

NPI: 1457591836
Provider Name (Legal Business Name): NORTHWEST NURSING, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/25/2009
Last Update Date: 06/17/2009
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4601 PALL MALL RD
BALTIMORE MD
21215-6414
US

IV. Provider business mailing address

921 E FORT AVE 240
BALTIMORE MD
21230-5134
US

V. Phone/Fax

Practice location:
  • Phone: 410-664-5551
  • Fax: 443-573-0236
Mailing address:
  • Phone: 410-625-1502
  • Fax: 410-625-7574

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: STEPHEN BELLONE
Title or Position: MANAGING MEMBER
Credential:
Phone: 410-625-1502