Healthcare Provider Details

I. General information

NPI: 1689971558
Provider Name (Legal Business Name): 6040 HARFORD ROAD OPERATIONS LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/11/2011
Last Update Date: 10/06/2025
Certification Date: 10/06/2025
Deactivation Date:
Reactivation Date:

III. Provider practice location address

6040 HARFORD RD
BALTIMORE MD
21214-1327
US

IV. Provider business mailing address

6040 HARFORD RD
BALTIMORE MD
21214-1327
US

V. Phone/Fax

Practice location:
  • Phone: 410-426-8855
  • Fax: 410-444-1260
Mailing address:
  • Phone: 410-426-8855
  • Fax: 410-444-1260

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number30025
License Number StateMA

VIII. Authorized Official

Name: MICHAEL T BERG
Title or Position: SECRETARY
Credential:
Phone: 610-444-6350