Healthcare Provider Details

I. General information

NPI: 1649725797
Provider Name (Legal Business Name): CROWNSVILLE HEALTH CARE LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 08/18/2016
Last Update Date: 03/07/2017
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1454 FAIRFIELD LOOP RD
CROWNSVILLE MD
21032-2006
US

IV. Provider business mailing address

1454 FAIRFIELD LOOP RD
CROWNSVILLE MD
21032-2006
US

V. Phone/Fax

Practice location:
  • Phone: 410-923-6820
  • Fax: 410-987-9157
Mailing address:
  • Phone: 410-923-6820
  • Fax: 410-987-9157

VI. Provider taxonomy

Scope of Practice (Provider specialty)

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

VIII. Authorized Official

Name: LEANNA LENNOX
Title or Position: VP
Credential:
Phone: 410-923-6820