Healthcare Provider Details

I. General information

NPI: 1275582140
Provider Name (Legal Business Name): MAPLEWOOD PARK RETIREMENT SERVICES INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 05/09/2006
Last Update Date: 12/17/2024
Certification Date: 12/17/2024
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9707 OLD GEORGETOWN RD
BETHESDA MD
20814-1745
US

IV. Provider business mailing address

9707 OLD GEORGETOWN RD
BETHESDA MD
20814-1745
US

V. Phone/Fax

Practice location:
  • Phone: 301-530-0500
  • Fax: 301-571-7411
Mailing address:
  • Phone: 15-300-5003
  • Fax: 301-571-7411

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number15-065
License Number StateMD

VIII. Authorized Official

Name: MR. TONY J. HARRIS
Title or Position: SENIOR REIMBURSEMENT MANAGER
Credential:
Phone: 703-854-0830