Healthcare Provider Details

I. General information

NPI: 1508854662
Provider Name (Legal Business Name): KESWICK MULTI CARE CENTER INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 10/12/2005
Last Update Date: 02/04/2020
Certification Date: 02/04/2020
Deactivation Date:
Reactivation Date:

III. Provider practice location address

700 W 40TH ST
BALTIMORE MD
21211-2104
US

IV. Provider business mailing address

700 W 40TH ST
BALTIMORE MD
21211-2104
US

V. Phone/Fax

Practice location:
  • Phone: 410-235-8860
  • Fax:
Mailing address:
  • Phone: 410-235-8860
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberMD30039
License Number StateMD

VIII. Authorized Official

Name: MR. BRET STINE
Title or Position: ADMINISTRATOR
Credential: AO
Phone: 410-662-4293