Healthcare Provider Details

I. General information

NPI: 1720938202
Provider Name (Legal Business Name): DIMPLES MANOR, INC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 02/02/2026
Last Update Date: 02/02/2026
Certification Date: 02/02/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1505 WINTERS CT
CAMBRIDGE MD
21613-2965
US

IV. Provider business mailing address

1505 WINTERS CT
CAMBRIDGE MD
21613-2965
US

V. Phone/Fax

Practice location:
  • Phone: 410-228-3135
  • Fax: 410-226-8511
Mailing address:
  • Phone: 410-228-3135
  • Fax: 410-226-8511

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code310400000X
TaxonomyAssisted Living Facility
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code3104A0625X
TaxonomyAssisted Living Facility (Mental Illness)
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code3104A0630X
TaxonomyAssisted Living Facility (Behavioral Disturbances)
License Number
License Number State

VIII. Authorized Official

Name: DAMION FFOLKES
Title or Position: DIRECTOR
Credential: FFOLKES
Phone: 443-636-1763