Healthcare Provider Details

I. General information

NPI: 1972785004
Provider Name (Legal Business Name): 1046 NORTH POINT, LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/30/2007
Last Update Date: 04/20/2010
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1046 OLD NORTHPOINT RD
BALTIMORE MD
21224-3307
US

IV. Provider business mailing address

1046 OLD NORTHPOINT ROAD
BALTIMORE MD
21224-3307
US

V. Phone/Fax

Practice location:
  • Phone: 410-282-0100
  • Fax:
Mailing address:
  • Phone: 410-766-1995
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number03-060
License Number StateMD

VIII. Authorized Official

Name: BRIAN FINGLASS
Title or Position: VP OF FINANCE/CFO
Credential:
Phone: 410-766-1995