Healthcare Provider Details

I. General information

NPI: 1295732006
Provider Name (Legal Business Name): XAVIER-CLINTON LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 07/07/2005
Last Update Date: 09/11/2025
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

9211 STUART LN
CLINTON MD
20735-2712
US

IV. Provider business mailing address

9211 STUART LN
CLINTON MD
20735-2712
US

V. Phone/Fax

Practice location:
  • Phone: 301-868-3600
  • Fax: 301-868-5883
Mailing address:
  • Phone: 301-868-3600
  • Fax: 301-868-5883

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License Number16001
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License Number16001
License Number StateMD

VIII. Authorized Official

Name: MS. CHARLOTTE SKAGGS
Title or Position: BOM
Credential:
Phone: 301-868-3600