Healthcare Provider Details

I. General information

NPI: 1003222944
Provider Name (Legal Business Name): CHESTERTOWN OPERATOR LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/10/2014
Last Update Date: 10/22/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

415 MORGNEC RD
CHESTERTOWN MD
21620-1046
US

IV. Provider business mailing address

14C 53RD ST STE 224N
BROOKLYN NY
11232-2644
US

V. Phone/Fax

Practice location:
  • Phone: 410-778-1900
  • Fax:
Mailing address:
  • Phone: 718-567-0400
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number14006
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code385H00000X
TaxonomyRespite Care
License Number
License Number State

VIII. Authorized Official

Name: SAM STERN
Title or Position: CFO
Credential:
Phone: 877-567-0402