Healthcare Provider Details

I. General information

NPI: 1083241210
Provider Name (Legal Business Name): FAHRNEY-KEEDY MEMORIAL HOME, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 03/26/2020
Last Update Date: 03/09/2022
Certification Date: 03/09/2022
Deactivation Date:
Reactivation Date:

III. Provider practice location address

8560 SYMPHONY DRIVE
BOONSBORO MD
21713
US

IV. Provider business mailing address

8507 MAPLEVILLE ROAD
BOONSBORO MD
21713
US

V. Phone/Fax

Practice location:
  • Phone: 301-671-5193
  • Fax: 301-671-5239
Mailing address:
  • Phone: 301-733-6284
  • Fax: 301-733-2733

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code261QA0600X
TaxonomyAdult Day Care Clinic/Center
License Number
License Number State

VIII. Authorized Official

Name: MR. STEPHEN P. COETZEE
Title or Position: PRESIDENT/CEO
Credential: LNHA
Phone: 301-671-5017