Healthcare Provider Details

I. General information

NPI: 1740563931
Provider Name (Legal Business Name): LORIEN LIFE CENTER - HOWARD II, INC.
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 09/23/2011
Last Update Date: 04/10/2012
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

7615 WASHINGTON BLVD
ELKRIDGE MD
21075-6443
US

IV. Provider business mailing address

3300 N RIDGE RD SUITE 390
ELLICOTT CITY MD
21043-3383
US

V. Phone/Fax

Practice location:
  • Phone: 410-579-2626
  • Fax:
Mailing address:
  • Phone: 410-750-7500
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code313M00000X
TaxonomyNursing Facility/Intermediate Care Facility
License NumberTO BE APPLIED FOR
License Number StateMD
# 2
Primary TaxonomyN
Taxonomy Code314000000X
TaxonomySkilled Nursing Facility
License NumberTO BE APPLIED FOR
License Number StateMD

VIII. Authorized Official

Name: MR. LOUIS G. GRIMMEL
Title or Position: VICE-PRESIDENT
Credential:
Phone: 410-750-7500