Healthcare Provider Details

I. General information

NPI: 1992805303
Provider Name (Legal Business Name): FREDERICK VILLA NURSING & REHAB
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/25/2006
Last Update Date: 08/22/2020
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

711 ACADEMY RD
BALTIMORE MD
21228-1802
US

IV. Provider business mailing address

711 ACADEMY RD
BALTIMORE MD
21228-1802
US

V. Phone/Fax

Practice location:
  • Phone: 410-788-3300
  • Fax: 410-788-6598
Mailing address:
  • Phone: 410-788-3300
  • Fax: 410-788-6598

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: MR. RICHARD GOLDSMITH
Title or Position: ADMINISTRATOR
Credential:
Phone: 410-788-3300