Healthcare Provider Details

I. General information

NPI: 1306313929
Provider Name (Legal Business Name): ELKTON SNF LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 11/01/2018
Last Update Date: 11/01/2018
Certification Date:
Deactivation Date:
Reactivation Date:

III. Provider practice location address

1 PRICE DR
ELKTON MD
21921-6731
US

IV. Provider business mailing address

1 PRICE DR
ELKTON MD
21921-6731
US

V. Phone/Fax

Practice location:
  • Phone: 410-398-6474
  • Fax:
Mailing address:
  • Phone:
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code225100000X
TaxonomyPhysical Therapist
License Number
License Number State
# 2
Primary TaxonomyN
Taxonomy Code225X00000X
TaxonomyOccupational Therapist
License Number
License Number State
# 3
Primary TaxonomyN
Taxonomy Code235Z00000X
TaxonomySpeech-Language Pathologist
License Number
License Number State

VIII. Authorized Official

Name: ISRAEL BIRNBAUM
Title or Position: AUTHORIZED REP
Credential:
Phone: 917-685-8278